Vancocin

For the treatment of initial episodes of Clostridium difficile infection; mild cases, if no response or intolerance to an adequate trial of oral metronidazole*:

*As defined by the Association of Medical Microbiology and Infectious Disease Canada treatment practice guidelines for Clostridium difficile infection, 2018.

Notes:
- Metronidazole 500mg orally three times daily for 10-14 days can be used in patients with mild diarrhea.
- Discontinue antibiotics for other indications if possible.
- Higher doses of vancomycin have not been shown to be beneficial.
- There is no evidence to support combination therapy with metronidazole or fidaxomicin.

Maximum funded dose: Vancomycin 125mg four times daily, up to 14 days

Maximum funded quantity: 56 capsules

For the treatment of initial episodes of Clostridium difficile infection; moderate or severe, uncomplicated cases*:

*As defined by the Association of Medical Microbiology and Infectious Disease Canada treatment practice guidelines for Clostridium difficile infection, 2018.

Notes:
- Metronidazole 500mg orally three times daily for 10-14 days can be used in patients with mild diarrhea.
- For mild to moderate cases, treatment should only be continued beyond 7 days if diarrhea persists, up to a maximum of 14 days.
- Severe, uncomplicated cases should be treated for 10-14 days. There is no evidence to support treatment durations beyond 14 days.
- Higher doses of vancomycin have not been shown to be beneficial.
- There is no evidence to support combination therapy with metronidazole or fidaxomicin.

Maximum funded dose: Vancomycin 125mg four times daily, up to 14 days

Maximum funded quantity: 56 capsules

For the treatment of recurrent Clostridium difficile infection (CDI), first recurrence, mild to moderate* or severe, uncomplicated* cases:

*As defined by the Association of Medical Microbiology and Infectious Disease Canada treatment practice guidelines for Clostridium difficile infection, 2018.

Notes:
- Recurrent CDI is defined as the reoccurrence of CDI within 8 weeks following the onset of a previous episode which resolved with treatment.
- Treatment should only be continued for 14 days.
- Higher doses or longer treatment duration with vancomycin have not been shown to be beneficial.
- There is no evidence to support combination therapy with metronidazole or fidaxomicin.

Maximum funded dose: Vancomycin 125mg four times daily, up to 14 days

Maximum funded quantity: 56 capsules

For the treatment of recurrent Clostridium difficile infection (CDI), second or subsequent recurrences, mild to moderate* or severe, uncomplicated* cases:

*As defined by the Association of Medical Microbiology and Infectious Disease Canada treatment practice guidelines for Clostridium difficile infection, 2018.

Notes:
- Recurrent CDI is defined as the reoccurrence of CDI within 8 weeks following the onset of a previous episode which resolved with treatment.
- There is no evidence to support combination therapy with metronidazole or fidaxomicin.

Funded dose: Vancomycin 125mg four times daily for 10-14 days, followed by vancomycin taper.

Maximum funded quantity: 114 capsules

Vancomycin

• Brand(s): Vancocin and other generics (Note that only specific DINs are reimbursed by the EAP)
• Dosage Form/Strength: 125 mg capsules, 250 mg capsules (on case-by-case basis only)

Effective September 30, 2019, Vancomycin oral tablets for the treatment of Uncomplicated Clostridium difficile infection may be accessed upon meeting Limited Use Criteria on the Ontario Drug Benefit Formulary.

Vancomycin Injection to be used as an oral solution for Clostridium difficile Infection may be accessed through the Telephone Request Service.

Case-by-case consideration for requests not meeting the Limited Use criteria (e.g., higher doses, longer durations, tapering regimens exceeding the dosing limits under LU, complicated C. difficile Infections) may be considered through external review. Please submit requests to EAP providing adequate and relevant clinical details to support the request.

EAP Drug Request Form:

Standard Form for EAP Drug Requests