TOPLINE

Oral vancomycin prophylaxis during broad-spectrum antibiotic therapy was associated with a lower risk for recurrent Clostridioides difficile infection (CDI) in children and young adults with cancer in a recent study.

METHODOLOGY

• Researchers conducted a retrospective study in the US to assess whether secondary vancomycin prophylaxis during broad-spectrum antibiotic administration reduced CDI in children and young adults with cancer.
• They identified 163 patients (median age, 9.3 years; 57.7% male) with primary CDI; after exclusions, 72 patients who received 150 courses of broad-spectrum antibiotics within 6 months following their initial CDI episode were included in the analysis. The mean duration of each antibiotic course was 9.1 days.
• Oral vancomycin was administered at a dose of 10 mg/kg (up to a maximum of 125 mg/dose) twice daily throughout subsequent courses of systemic broad-spectrum antibiotics; 15 of 72 patients received a total of 27 courses of oral vancomycin.
• Propensity score matching resulted in 49 broad-spectrum antibiotic episodes from 19 patients, forming 11 matched sets for outcome analysis.
• Study outcome was CDI recurrence. The analysis adjusted for time from the index CDI episode, number of prior broad-spectrum antibiotic courses, average daily Antibiotic Spectrum Index (ASI), antifungal administration, and receipt of proton pump inhibitors or histamine-2 receptor blockers.

TAKEAWAY

• Among the 150 broad-spectrum antibiotic episodes, 24 CDI recurrences (16.0%) were observed; in the matched dataset of 49 episodes, the CDI recurrence rate was lower with vancomycin (2 of 27 episodes; 7.4%) than without vancomycin (4 of 22 episodes; 18.2%).
• Receipt of vancomycin was significantly associated with reduced odds of CDI recurrence in the adjusted propensity score-matched model (adjusted odds ratio [OR], 0.074; 95% CI, 0.01-0.54; P = .01).
• Higher average daily ASI was associated with lower odds of CDI (OR, 0.55; 95% CI, 0.34-0.91; P = .02), as was a greater number of prior broad-spectrum antibiotic courses (OR, 0.36; 95% CI, 0.16-0.82; P = .02).
• In a post hoc analysis of the first 8 weeks after index CDI, 51 patients received broad-spectrum antibiotics and six received vancomycin, and eight developed recurrent CDI; all recurrences occurred among patients who did not receive prophylaxis.

IN PRACTICE

“Administration of oral vancomycin secondary prophylaxis to children and adolescents with cancer during courses of broad-spectrum antibiotic therapy was significantly associated with reduced odds of CDI in the 6 months following a patient’s index CDI episode,” the authors of the study wrote.

SOURCE

The study was led by Isabela DeJohn, University of Cincinnati College of Medicine, Cincinnati. It was published online on June 20, 2026, in Open Forum Infectious Diseases.

LIMITATIONS

Potential misclassification of patients with prior CDI history or those who developed CDI during follow-up could have occurred. Small sample size limited precision and generalizability. Course-level analysis could have been biased by informative censoring. Additionally, positive C difficile tests could be asymptomatic colonization rather than true infection.

DISCLOSURES

This study received funding support from the University of Cincinnati College of Medicine Medical Student Scholars Program and the John Hauck Foundation. The authors reported no conflicts of interest related to this work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.