Chloramphenicol for the Treatment of Vancomycin-Resistant Enterococcal Infections

Abstract

A retrospective study of patients who received chloramphenicol for the treatment of serious vancomycin-resistant enterococcal infections between 1 January 1993 and 31 August 1993 was conducted at the University of Pennsylvania Medical Center (Philadelphia). Antimicrobial susceptibilities as well as the clinical course of infection, adverse events, and response to therapy of 16 patients were reviewed. Forty-seven percent of enterococcal isolates were susceptible only to chloramphenicol, tetracycline, and nitrofurantoin. Types of infection included bacteremias (n = 7), abscesses (n = 7), and others (n = 5). Of 14 patients for whom a clinical response could be ascertained, eight (57%) showed improvement after treatment. Of 11 patients for whom a microbiological response could be ascertained, eight (73%) had sterile cultures after treatment. No lasting adverse effect related to the drug occurred. In-hospital mortality was 56%, but only one death could be directly attributed to vancomycin-resistant enterococcal infection. Chloramphenicol appears to be a useful and well-tolerated agent for the treatment of serious vancomycin-resistant enterococcal infections.

Vancomycin-Resistant Enterococci

“…This agent has been used with limited (no reduction in mortality) or modest success in the treatment of VRE infections (200,201). This was illustrated in a retrospective review of 16 patients with serious VRE infections (e.g., bacteremias and abscesses) who were treated with chloramphenicol at a university teaching institution (194). All the isolates were resistant to several antibiotics but were susceptible to chloramphenicol.…”

“…E100, 1994). RP 59500 was first made available for use under an investigator-sponsored investigational newdrug program for treatment of patients with life-threatening infection due to vancomycin-resistant E. faecium (194). It is the first antibiotic approved for the treatment of patients with serious or life-threatening infections associated with vancomycin-resistant E. faecium bacteremia.…”

Incidence and outcome of vancomycin-resistant enterococcal bacteremia following autologous peripheral blood stem cell transplantation

“…every 6 h has been utilized with moderate success and without any significant and irreversible adverse hematologic sequelae. 22 Other agents such as doxycycline, 23 nitrofurantoin, 24 co-trimoxazole and oral bacitracin 25 have also been used to treat VRE infection. Oral bacitracin was utilized in the treatment of two of our patients with persistent bacteremia as an adjunct to other anti-microbial agents.…”

Vancomycin use in a hospital with high prevalence of Methicillin-Resistant Staphylococcus aureus: comparison with Hospital Infection Control Practices Advisory Committe Guidelines (HICPAC)

“…Because exposure to vancomycin has been identified as a strong risk factor for colonization and infection with VRE, the HICPAC guidelines recommend that healthcare centers adopt measures to ensure the prudent use of vancomycin and outline 5 clinical situations that justify the use of vancomycin and 12 situations in which its use should be discouraged [30][31][32]. Several American studies have measured the appropriateness of vancomycin use based on these guidelines, with estimates of appropriate use ranging from 20% to 40%, in absence of restriction policies [20,[33][34][35].…”