Is Liquid Vancomycin Better Than Capsule?

Posted on Wed, 26 Apr 2017

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Wed, 26 Apr 2017 Answered on

Sat, 13 May 2017 Last reviewed on

Question : Which is better liquid vancomycin or capsule?My husband is 87 and he got c-diff at a rehab and it keeps coming back

Answered by Dr. Dr. Michelle Gibson (-4 hours later)

Brief Answer:
no documented difference in medication

Detailed Answer:
HI, thanks for using healthcare magic

There is no difference in treatment outcome between the two medications.

This was confirmed in a medical study which was reported in the Journal of Pharmacology Practice called 'Comparison of Oral vancomycin capsule and solution for treatment of initial episode of severe c diff infection'. It looked at cases between 2006 and 2011.

It found that there was no difference between the two formulations for most persons.

Individuals reaction to medication varies so it is possible that he may have a better reaction with the different type of medication but there is no documented difference in medication.

I hope this helps, feel free to ask any other questions

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Michelle Gibson (8 hours later)

My husband's c-diff seemed cured (after many weeks of tampering down the vanco). But after being off medication for a week it came rushing back. He had put one small dab of Mupirocin ointment on the out side of his ear at night and in the morning it came rushing back. Could this have any thing to do with it? I think his c-diff came back once or twice before but his stool (except the original infection) was never tested so we did not know for sure. The doctor just gave him vanco. This time it was tested and he has it.

Answered by Dr. Dr. Michelle Gibson (1 hour later)

Brief Answer:
not a known complication of topical medication

Detailed Answer:
HI

The topical ointment should not precipitate this infection, it occurs as a result of disturbance of the normal bacteria in the colon. The topical medication would not have this systemic effect

Unfortunately relapse is common, it occurs in 20 to 27% of cases and generally occur 3 days to 3 weeks after treatment is discontinued.

Moderate or severe relapses can be treated with vancomycin , as with your husband. Mild relapses are sometimes monitored to allow the normal bacteria of the colon to come back with being disrupted by more antibiotics

If the infection is moderate/severe then medication is needed.
The dose of vancomycin is sometimes either a prolonged course that is tapered off or pulse (meaning give a few days stop, restart, stop etc)

In 2016, the FDA approved a new drug called bezlotoxumab for c diff. This binds to the toxin and neutralizes it.

Last option is a procedure called fecal transplantation. This is done if they are severe repetitive episodes.
Essentially stool from a normal person, which has normal bacteria found in the colon is placed in a person with c diff

please feel free to ask anything else

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar