A lower cost option for prescribing oral vancomycin

I do get irritated by some things I see happening to IBD patients. There is an infectious condition called Clostridium difficile colitis which can be treated with antibiotics. One antibiotic, vancomycin, is very expensive when used in the capsule formulation, but inexpensive when supplied as a solution.

Vancomycin is a treatment for C. Difficile colitis, but can it be obtained for less than $1000?

I had a patient, recently, who is uninsured who was treated for C. difficile colitis. I was saddened to hear that she was given a prescripiton for oral vancomycin capsules. If there is one way to sour a self-pay patient on modern medicine it is to prescribe off patent medications in an expensive formulation. I have to say I learned this trick a long time ago from a coleague. I regret I don’t recall who told me, but it saves thousands of dollars.

Do I exagerate? No! Vancomycin capsules for a 10 day course of 250 mg four times a day cost upwards of $1000? So, how do you save money? Get a pharmacist to dispense the solution used for IV administration.

IV vancomycin has been available for years for about $15 for a 10 gram dose. That is just the amount needed for an oral course of therapy. Just have the pharmacist mix up the following:

Vancomycin HCl 10 g inj.1 vial
Saccharin Sodium0.4 g
Stevia0.4 g
Glycerin80 ml
Raspberry concentrate0.2 ml
Distilled waterqs 200 ml

This has a stability of 14 days if refrigerated. She has Crohn’s disease and has recurrent C. diff which I found upon scoping her, today. This script will cost about $50-$80, saving her about $900 to $1000. She thinks I’m great for having found this cheaper alternative. Next step may be a stool transplant (which might cure her Crohn’s!).

I found this recipe for compounding Vancomycin at the American Society of Health-System Pharmacists web site. The internet is a wonderful place, and Google serves us well. The recent script I wrote left out the Stevia, and just ordered “flavor, prn”, leaving that to the judgement of the pharmacist. Don’t fear writing a compounding prescription. Pharmacists are our friends, and they like the chance to provide this service to our patients.

Author: Stephen Holland

Stephen Holland, M.D. went to medical school at Northwestern University in Chicago, then did his medical residency at Loyola in Maywood (just West of Chicago). He then did research at the University of Alabama at Birmingham, did his GI fellowship there, and went to the University of Illinois at Peoria to teach and do research. He ran a successful private practice for over 12 years in Naperville, Illinois. Most recently he was chief of GI at Mt. Sinai Hospital in Chicago for 5 years.

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