Systematic Review and Meta-Analysis: Efficacy of Vancomycin Taper and Pulse Regimens in Clostridioides difficile Infection

ABSTRACT

Background

Vancomycin is the drug of choice for treating Clostridioides difficile infection (CDI). We compare CDI resolution with vancomycin taper, pulse, and taper-and-pulse regimens.

Methods

We searched for Medline, Embase, Cochrane, and Scopus through October 9^th, 2020. Taper regimen was defined as dose reduction over time; pulse was a regimen less frequent than daily. Studies assessing CDI resolution rates were included. Meta-analyses for resolution rates were performed using weighted proportion ratios (WPR).

Results

Ten studies with 675 patients treated with vancomycin regimens were included. Resolution rates were 83% (212/266, 95% CI 69–94%, I² = 85%) for taper-and-pulse, 68% (264/383, 95% CI 57–78%, I² = 72%) for taper alone, and 54% (11/26 95% CI 0–100%, I² = 86%) for pulse alone regimens. Taper-and-pulse was superior to taper alone (WPR 83% vs 68%, p < 0.0001) and pulse alone (WPR 83% vs 54%, p < 0.0004), no significant difference between taper alone or pulse alone (WPR 68% vs 54%, p = 0.1).

Conclusions

Limitations of our analysis are a small number of included studies and heterogeneity. Vancomycin taper-and-pulse seems superior to pulse alone or taper alone for recurrent CDI. A randomized controlled trial comparing vancomycin taper-and-pulse to fidaxomicin and microbiome restoration is needed.

KEYWORDS:

• Clostridioides difficile
• pulse
• recurrence
• taper
• vancomycin

Author contributions

KS: design of the study, collection, and interpretation of data, drafting of manuscript; IZ: design of the study, collection, and interpretation of data, revision of manuscript; RT: interpretation of data, revision of manuscript; DSP: conceptualization of study, revision of manuscript; SK: conceptualization of study, design of the study, drafting of manuscript. All authors have reviewed and agreed on the article before submission. All authors agreed to take responsibility and be accountable for the contents of the article and to share responsibility to resolve any questions raised about the accuracy or integrity of the published work. Ethical Approval and Patient Consent is not required.

Previous presentations

Presented at the 31st European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) as an eposter, virtually, from 9 – 12 July 2021.

Supplementary materials

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was not funded