Have you used oral vancomycin as prophylaxis for C difficile infection in patients admitted for allogeneic hematopoietic cell transplant?

Yes, but only in patients with a history of C difficile in the previous year and starting at the time of initiation of broad-spectrum antibiotics (e.g., for fever and neutropenia). We use 125 mg daily.

We are aware this practice may be controversial. To my knowledge, there is only one randomized trial of oral vancomycin for primary prophylaxis of C difficile (Johnson et al., PMID 31560051). This was an open-label, single-institution, small clinical trial that did not include allogeneic hematopoie...

We also use oral vancomycin as secondary prophylaxis for anyone who develops C difficile infection, at a dose of vancomycin 125 mg PO BID, for up to 7 days after concurrent antibiotics are discontinued. This recommendation is based on Morrisette et al., PMID 31255741, a retrospective cohort study of adult patients with a history of a hematologic malignancy and/or a history of auto or alloHCT with C diff infection treated with oral vancomycin and receiving concomitant broad-spectrum antibiotics a...