Pragmatic Studies and Vancomycin for Recurrent C. difficile Prevention!

I like pragmatic studies, as previously written here.

Here is an article on the efficacy of oral vancomycin for the prevention of recurrent C. difficile. Now this is by no means a slam dunk article in support of oral vancomycin as preventive therapy for patients receiving systemic antibiotics and who have a history of prior C.difficile infection. The authors reported a significant decrease in C. difficile infection in patients receiving prophylaxis (4.2% vs 26.6%).

While this may not be the optimal, prospective, randomized study, a vexing and important clinical problem, the prevention recurrent C. difficile infection, is tackled by assessing existing data via a formal retrospective methodology, a pragmatic solution. Important clinical questions remain such as what is the optimal dose of vancomycin (or another agent, such as fidaxomicin), duration of treatment, and the impact of prophylaxis on the fecal microbiota?

Regardless, this pragmatic study gives us some empiric data to guide our 'real life' management of recurrent C. difficile prevention. 

The use of oral vancomycin to prevent C. difficile recurrence in patients on systemic antibiotics is not just hocus pocus.