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Vancomycin inhibits bacterial cell wall synthesis by binding to peptidoglycan precursors. When taken orally, it is not absorbed from the GI tract, achieving very high colonic concentrations where C. difficile colonizes. This provides effective local treatment without systemic side effects associated with IV vancomycin.
Brand Vancocin capsules cost $500–$2000+ per course. Compounding pharmacies prepare oral vancomycin solution (125–250mg/5mL) and custom capsule doses at dramatically lower cost—making treatment financially accessible for uninsured or underinsured patients.
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C. difficile infection is among the most common healthcare-associated infections, and oral vancomycin is a first-line treatment per IDSA guidelines. The dramatic cost difference between compounded and brand vancomycin makes compounding medically and economically essential. The oral solution is particularly valuable for patients unable to swallow capsules and for pediatric patients.
Clostridioides difficile (C. diff) colitis (standard and severe), recurrent C. diff with taper protocol, enterococcal enteritis.
Standard C. diff: 125mg orally 4 times daily for 10–14 days. Severe C. diff: 500mg orally 4 times daily. Recurrent C. diff taper: 125mg 4x/day for 14 days, then slowly taper over 4–6 weeks. Pediatric: 40mg/kg/day in 3–4 divided doses.
Generally very well tolerated due to minimal systemic absorption. Mild GI side effects and bad taste possible. Does not cause nephrotoxicity or ototoxicity associated with IV vancomycin. May disrupt gut microbiome.
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