High-Dose Vancomycin in the Treatment of Clostridioides difficile Infection

Background There is significant variability in guideline recommendations regarding the dosing of vancomycin in treating Clostridioides difficile infection (CDI). The aim of this systematic review and meta-analysis was to investigate the efficacy of high-dose vancomycin compared with other current standard of care and other CDI treatment regimens. Methods We conducted a comprehensive literature search in PubMed, the Cochrane Library, Embase, and Web of Science for publications that studied the comparative effectiveness of high-dose vancomycin to other CDI treatment regimens for the period up to July 2020. Results A total of 14 studies, 6 randomized controlled trials (372 participants) and 8 observational controlled studies (952 participants), with a total of 1324 patients were included in the final analysis. There was no statistically significant effect between high-dose vancomycin and other treatment options of CDI on clinical cure/response (odd ratio [OR], 0.70; 95% confidence interval [CI], 0.34 to 1.43; I 2 = 59%), clinical relapse and recurrence (OR, 1.01; 95% CI, 0.72–1.42; I 2 = 61%), and mortality (OR, 1.03; 95% CI, 0.37–2.84; I 2 = 44%). Conclusions High-dose oral vancomycin was not superior to other treatment regimens for the outcomes of clinical response and cure, recurrence, and mortality of CDI.