Low dose antibiotic treatment of C-difficile as effective as high dose in hospital setting

(Press-News.org) NEW YORK (September 11, 2013) – Clostridium difficile infection (CDI) treatment in a hospital setting using low dose oral vancomycin showed similar effectiveness compared to high dose, according to a new study by researchers at Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University. These data were presented yesterday at the 53rd Annual Interscience Conference on Antimicrobial Agents and Chemotherapy meeting in Denver.

Patients with CDI treated with vancomycin at the low dose (LD) (125 mg every 6 hours) and high dose (HD) (greater than 125mg every 6 hours) showed clinical improvements 72 hours after administration (85% and 86%, respectively).

CDI is an infection of the large bowel that can result in mild to severe symptoms including stomach pain, severe cramping, profuse diarrhea, and, in the most severe form, can lead to death. CDI is linked to 14,000 deaths each year in the United States, according to the Centers for Disease Control and Prevention.

"This study's comparable results in low dose and high dose antibiotic treatment of CDI reinforce the importance of considering new approaches to using these medications," said Philip Chung, PharmD, M.S., clinical pharmacy manager in Infectious Diseases, Montefiore Medical Center and assistant professor of medicine, Department of Medicine (Infectious Diseases), Einstein. "Antibiotic stewardship is an important focus in hospitals today. We are using our study findings to develop treatment guidelines that encourage low dose treatment."

Comparable results in the LD and HD groups were shown in secondary endpoints, including rates of clinical improvement at end of therapy or time of hospital discharge (93% and 95%, respectively), in-hospital mortality (15% and 23%), re-treatment (4% and 6%), and 30-day readmission (34% and 24%).

"Montefiore is committed to the appropriate use of antibiotics through a multi-disciplinary Antimicrobial Stewardship Team that supports better patient care and safety, improved clinical outcomes and reduced resistance and healthcare-acquired infections such as CDI," said infectious diseases specialist Belinda Ostrowsky, M.D., M.P.H., director, Antibiotic Stewardship Program, Montefiore and associate professor of clinical medicine, Department of Medicine (Infectious Diseases), Einstein. "Based on our study results, we know making small changes can make a big difference without impacting patient care in a hospital setting. These results are encouraging and we plan to continue exploring other ways to impact antibiotic use."

This retrospective study included 300 patients (197 LD, 103 HD) hospitalized at Montefiore between 2006 and 2010 who had a diagnosis of diarrhea associated CDI and received at least 72 hours of oral vancomycin. Medical records of eligible patients were reviewed for demographics, clinical and laboratory parameters for resolution of infection, other antibiotics prescribed during treatment of CDI, death during hospitalization and hospital readmission within 30-days after discharge.

In addition to Dr. Chung and Dr. Ostrowsky, other researchers involved in the study are Montefiore pharmacist Monica Ramirez, PharmD, and clinical pharmacy managers Angela Cheng, PharmD, (also assistant professor of medicine, Department of Medicine (Cardiology) at Einstein), Toshiba Morgan-Joseph, PharmD, and Yi Guo, PharmD, (also assistant professor of medicine, Department of Medicine (Infectious Disease) at Einstein).

### About Montefiore Medical Center As the University Hospital for Albert Einstein College of Medicine, Montefiore is a premier academic medical center nationally renowned for its clinical excellence, scientific discovery and commitment to its community. Recognized among the top hospitals nationally and regionally by U.S. News & World Report, Montefiore provides compassionate, patient- and family-centered care and educates the healthcare professionals of tomorrow. The Children's Hospital at Montefiore is consistently named in U.S. News' "America's Best Children's Hospitals," and is second among those in the New York metro area. With four hospitals, 1,491 beds and 90,000 annual admissions, Montefiore is an integrated health system seamlessly linked by advanced technology. State-of-the-art primary and specialty care is provided through a network of more than 130 locations across the region, including the largest school health program in the nation and a home health program. Montefiore's partnership with Einstein advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. The medical center derives its inspiration for excellence from its patients and community, and continues to be on the frontlines of developing innovative approaches to care. For more information please visit http://www.montefiore.org and http://www.montekids.org. Follow us on Twitter; like us on Facebook; view us on YouTube.

About Albert Einstein College of Medicine of Yeshiva University Albert Einstein College of Medicine of Yeshiva University is one of the nation's premier centers for research, medical education and clinical investigation. During the 2012-2013 academic year, Einstein is home to 742 M.D. students, 245 Ph.D. students, 116 students in the combined M.D./Ph.D. program, and 360 postdoctoral research fellows. The College of Medicine has more than 2,000 full-time faculty members located on the main campus and at its clinical affiliates. In 2012, Einstein received over $160 million in awards from the NIH. This includes the funding of major research centers at Einstein in diabetes, cancer, liver disease, and AIDS. Other areas where the College of Medicine is concentrating its efforts include developmental brain research, neuroscience, cardiac disease, and initiatives to reduce and eliminate ethnic and racial health disparities. Its partnership with Montefiore Medical Center, the University Hospital and academic medical center for Einstein, advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. Through its extensive affiliation network involving Montefiore, Jacobi Medical Center–Einstein's founding hospital, and five other hospital systems in the Bronx, Manhattan, Long Island and Brooklyn, Einstein runs one of the largest residency and fellowship training programs in the medical and dental professions in the United States. For more information, please visit http://www.einstein.yu.edu, read our blog, follow us on Twitter, like us on Facebook, and view us on YouTube.