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Table 2 Summary of gastrointestinal decolonization of vancomycin-resistant Enterococcus by antimicrobial therapy

From: Decolonization of gastrointestinal carriage of vancomycin-resistant Enterococcus faecium: case series and review of literature

Ref Country/year of publication/study setting Decolonization regimens/study end point(if mentioned) Results at study end point Microbiology culture methods/presence of broth enrichment or not
[7] US/1994/observational study Oral vancomycin 125 mg q6h for 10 daysa/follow up for 15 days post treatment VRE negative in 8 (42%) of 19 patients Campylobacter agar containing 10 μg/ml of vancomycin (B-D Microbiology Systems, Cockeysville, MD, USA)/no broth enrichment
[7] US/1994/observational study Oral bacitracin 25,000 U (500 mg) q6h for 10 days/follow up for 15 days post treatment VRE negative in 8 (100%) of 8 patients Campylobacter agar containing 10 μg/ml of vancomycin (B-D Microbiology Systems, Cockeysville, MD, USA)/no broth enrichment
[15] US/1995/observational study Oral novobiocin (500 mg q6h plus oral tetracycline 500 mg q6h (five patients) or intravenous doxycycline 100 mg q12h (one patient) for a median of 3.5 days (range, 1 to 6 days) VRE negative in only one patient while receiving decolonization therapy Not mentioned
[8] US/1995/observational study Bacitracin 25,000 U (diluted in 5 mL of 0.9% normal saline) given orally or by gastrostomy tube twice a day for 10 days/follow up for 3 weeks post treatment VRE negative in 5 (63%) of 8 patients Not mentioned
[9] Canada/1999/prospective observational cohort study in a tertiary care institution Oral doses of bacitracin solution (75,000 U/15 mL) four times daily and doxycycline 100 mg once daily for 14 days/follow up for 4 months VRE negative in 15 (100%) of the antibiotic treated vs 8 (33.3%) of the untreated patients (P <0 .001) at the end of treatment; but VRE positive in 9 (60%) of 15 and 15 (62.5%) of 24 in the treated and untreated cohort (p = 0.86) following up for a mean of 127 and 130 days respectively b M-enterococcal agar with vancomycin (6 mg/mL)/no broth enrichment
[10] US/2001/randomized, controlled study Oral zinc bacitracin (50,000 U) q6h for 10 days vs placebo/follow up for 3 weeks post treatment VRE negative in 2 (33%) of 6 patients in each group after 3 weeks post treatment Bile esculin agar plates supplemented with 6 mg/mL of vancomycin/no broth enrichment
[14] US/2001/phase II, double-blinded, randomized, multicenter, placebo-controlled study Oral ramoplanin: 2 daily doses of 100 mg or 400 mg or placebo for 7 days/follow up on day 0, 7, and 14 post treatment Day 0: VRE negative in 17 (81%) of 21 and 18 (90%) of 20 patients in the 100-mg and 400-mg ramoplanin groups; Day 7: VRE negative in 6 (29%) of 21 and 7 (41%) of 17 in the 100-mg and 400-mg ramoplanin groups; Day 14: VRE negative in 4 (21%) of 19 and 5 (29%) of 17 patients in the 100-mg and 400-mg ramoplanin groupsc Bile-esculin azide broth that contained 6 mg/mL of vancomycin (Hardy Diagnostics)/broth enrichment
[12] US/2002/observational study Oral bacitracin (25,000 U three times daily) and oral gentamicin (80 mg three times daily) for a mean duration of 16 days (median, 14 days; range, 7 to 29 days)/follow up for 3 months post treatment VRE negative in 5 (17.8%) of 28 patients Not mentioned
[11] France/2010/observational study in a geriatric rehabilitation care facility Oral bacitracin 30,000 U three times daily for 15 days/follow up for 6 months VRE negative in 3 (43%) of 7 patients at the end of therapy and at 6 months Not mentioned
[11] France/2010/observational study in a geriatric rehabilitation care facility Bacitracin 30,000 U three times daily plus streptomycin 1 g once daily orally for 15 days/follow up for 6 months VRE negative in 3 (75%) of 4 patients at the end of therapy and at 6 months Not mentioned
  1. Note. U, units; VRE, vancomycin-resistant enterococci; ahigh intraluminal concentrations attained with oral vancomycin administration greatly exceed the MICs of VRE; bQuantitative VRE stool cultures in the treated cohort revealed an initial 3.1 log10/g decrease, but there was an increase to pretreatment levels of 7.8 and 7.4 log10/g at 2–4 and 5–7 weeks post-treatment respectively; cFor placebo group, VRE negative in none of 20 patients in day 0, 2 (10%) of 20 patients in day 7, and 5 (25%) of 20 patients in day 14 post treatment.