Lack of Efficacy of Oral Bacitracin Plus Doxycycline for the Eradication of Stool Colonization with Vancomycin-Resistant Enterococcus faecium

• Published in: Clinical infectious diseases 1999-08, Vol.29 (2), p.361-366
• Main Authors: Weinstein, Mitchell R., Dedier, Helen, Brunton, James, Campbell, Iivi, Conly, John M.
• Format: Article
• Language: English
• Subjects: Administration, Oral; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antimicrobials; Bacitracin - therapeutic use; Biological and medical sciences; Clinical Articles; Control groups; Diseases; Doxycycline - therapeutic use; Drug Resistance, Microbial; Drug Therapy, Combination; Enterococcus faecium; Enterococcus faecium - drug effects; Enterococcus faecium - growth & development; Epidemiology; Feces - microbiology; Female; Follow-Up Studies; Gram-Positive Bacterial Infections - drug therapy; Gram-Positive Bacterial Infections - microbiology; Hospital units; Humans; Infections; Longitudinal Studies; Male; Medical sciences; Microbial colonization; Middle Aged; Patient surveillance; Pharmacology. Drug treatments; Prospective Studies; Vancomycin - pharmacology
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/520216

In a prospective observational cohort study designed to assess the role of oral bacitracin solution plus doxycycline in the eradication of intestinal carriage of vancomycin-resistant Enterococcus faecium (VREF) in patients on a renal ward, rectal swab specimens were obtained from 15 treated and 24 control patients. Cultures of the rectal swabs were negative for 15 (100%) of the antibiotic-treated vs. eight (33.3%) of the untreated patients (P < .001) on day 14. However, follow-up for a mean of 127 and 130 days revealed 9 of 15 (60%) and 15 of 24 (62.5%) in the treated and untreated cohorts (P = .86), respectively, carried VREF intermittently or persistently. Quantitative VREF stool cultures in the treated cohort revealed an initial 3.1-log10/g decrease, but there was an increase to pretreatment levels at 2–4 and 5–7 weeks post-treatment (7.8 and 7.4 log10/g). Oral bacitracin and doxycycline were not efficacious in reducing the carriage of VREF beyond the 2-week interval during which they were given.