{
  "abstract": "Background and Importance The latest guidelines for the management of Clostridioides difficile infection (CDI) indicate, in patients without risk factors for relapse and in the first episode of infection, oral vancomycin 125 mg/6 hours for 10 days. However, there is no commercially available oral vancomycin in Spain, so the options are either vancomycin vials after oral reconstitution, or a compounded formulation of vancomycin capsules.Before 2023, only vials were used in our community; thereafter, the use of capsules was prioritised.Aim and objectives Hypothesis: Vial manipulation negatively influences CDI resolution.Objective: To analyse whether the pharmaceutical form of vancomycin used for the treatment of CDI influences its effectiveness, measured as the percentage of patients who relapse.Material and Methods Retrospective observational study. Adult patients receiving oral vancomycin for CDI between 01/07/2023 and 01/07/2025 were included. The following variables were collected: age, vancomycin pharmaceutical form, presence of relapse (3 months post-treatment), subsequent lines of treatment, serum leukocyte, albumin and creatinine levels, and concomitant antibiotic treatment during CDI treatment. The ATLAS score was calculated to estimate the risk of relapse of each patient. When the score is three or higher mortality rate rises to 3.6% and the cure rate decreases to 89.5%.Results We included 107 patients receiving oral vancomycin (53 received capsules and 54 vials). The median age of patients in both groups was similar (70.0 vs 70.4 years). First-line treatment was capsules in the 90.5% of patients and vials in 85.2%. Patients receiving capsules had an average risk of relapse (SCORE ATLAS) of 3.15 points versus 2.70 points in patients receiving vials (p=0.01). Relapse rate was 11.3% for patients treated with capsules versus 24.1% of those receiving vials (p=0.08) (13). Only four patients switched from vancomycin vials to capsules for second-line treatment; the rest used fidaxomicin. At the end, 100% of the CDI cases resolved.Conclusion and Relevance Patients treated with capsules had a higher risk of relapse but also a higher cure rate than patients treated with oral reconstituted vancomycin vials.The difference may not have been statistically significant due to the small sample size.Handling vancomycin vials could be a risk factor for relapse in the resolution of the CDI.Conflict of Interest No conflict of interest",
  "authors": [
    {
      "affiliations": [
        "Subdirección De Farmacia Y Prestaciones, Servicio De Asesoría E Información Del Medicamento, Pamplona, Spain"
      ],
      "name": "M Marín"
    },
    {
      "affiliations": [
        "Subdirección De Farmacia Y Prestaciones, Servicio De Asesoría E Información Del Medicamento, Pamplona, Spain"
      ],
      "name": "A Rodriguez"
    },
    {
      "affiliations": [
        "Subdirección De Farmacia Y Prestaciones, Servicio De Asesoría E Información Del Medicamento, Pamplona, Spain"
      ],
      "name": "A Echeverria"
    },
    {
      "affiliations": [
        "Subdirección De Farmacia Y Prestaciones, Servicio De Asesoría E Información Del Medicamento, Pamplona, Spain"
      ],
      "name": "J Gorricho"
    },
    {
      "affiliations": [
        "Hospital Universitario De Navarra, Microbiology, Pamplona, Spain"
      ],
      "name": "A Gil"
    },
    {
      "affiliations": [
        "Subdirección De Farmacia Y Prestaciones, Servicio De Gestión De La Prestación Farmacéutica, Pamplona, Spain"
      ],
      "name": "O Goñi"
    },
    {
      "affiliations": [
        "Subdirección De Farmacia Y Prestaciones, Servicio De Asesoría E Información Del Medicamento, Pamplona, Spain"
      ],
      "name": "L Sanz"
    },
    {
      "affiliations": [
        "Subdirección De Farmacia Y Prestaciones, Servicio De Asesoría E Información Del Medicamento, Pamplona, Spain"
      ],
      "name": "J Garjon"
    },
    {
      "affiliations": [
        "Subdirección De Farmacia Y Prestaciones, Servicio De Asesoría E Información Del Medicamento, Pamplona, Spain"
      ],
      "name": "J Fernandez"
    }
  ],
  "title": "3PC-001 Oral vancomycin: vials vs capsules",
  "uid": "ebd01fe8-ffb0-5d73-8515-7af2e522d38f"
}