Grant: Project Grant

Clostridium difficile infection (CDI) is a diarrheal illness that often comes from taking antibiotics or being in the hospital. It affects 37,000 Canadians a year with an estimated cost of $281 million. CDI can cause complications such as hospital admission, difficult to treat diarrhea with dehydration, kidney injury, and sometimes even surgical removal of the colon or death. Even with proper treatment, more than one quarter of patients develop another episode, called a recurrence, within a few months. There is an urgent demand for strategies to prevent these recurrences. Despite this pressing need, the evidence for the best initial treatment of CDI is limited. There is some evidence that taking vancomycin for longer and at decreasing doses (tapering) may reduce the risk of recurrence. Oral vancomycin is inexpensive and if tapering decreases CDI recurrence this would be a major finding. We will conduct a randomized controlled trial of an additional 14 days of vancomycin as compared to a placebo and evaluate for a reduction in the rate of recurrence. This trial will involve community-dwelling and hospitalized adults at one of 17 hospitals across Canada (affiliated with the Universities of British Columbia, Ottawa, Sherbrooke, Toronto, Queen's and McGill). The primary outcome will be recurrence between 14 and 56 days of initial treatment. We will also look at whether patients are less likely to die, be admitted to hospital, or need rescue therapies like stool transplantation or surgical removal of the colon. This project will provide important scientific evidence for or against vancomycin tapering for the prevention of recurrent CDI. This study has never been performed and right now doctors and patients rely on historical practice and small, limited studies to make decisions. Public funding for this study will help our team determine the best treatment to prevent patients from developing CDI a second or third time, eliminating a sizable burden of disease.