Oral vancomycin may have significant absorption in patients with Clostridium difficile colitis

Chihara, Shingo; Shimizu, Riha; Furukata, Satoshi; Hoshino, Koichi

doi:10.3109/00365548.2010.513066

Cited by 15 publications

(8 citation statements)

References 10 publications

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“…Vancomycin toxicity has been observed in isolated cases where reduced colonic barrier function and poor clearance of absorbed vancomycin were suspected [26]. There have also been reports of appreciable circulating levels of vancomycin following oral administration without apparent toxicity in patients with or without CKD [27]. Other investigations found no evidence of absorption in patients with severe CDI and/or CKD [28].…”

Section: Discussionmentioning

confidence: 99%

Renal Impairment and Clinical Outcomes of <i>Clostridium difficile</i> Infection in Two Randomized Trials

et al. 2013

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Background/Aims: Patients with chronic kidney disease (CKD) have increased risk for Clostridium difficile infection (CDI) and for subsequent mortality. We determined the effect of CKD on response to treatment for CDI. Methods: This is a post hoc analysis of two randomized controlled phase 3 trials that enrolled patients with CDI. Patients received either fidaxomicin 200 mg b.i.d. or vancomycin 125 mg q.i.d. for 10 days. Univariate and multivariate analyses compared end points by treatment received and CKD stage. Results: At baseline, 27, 21, and 9% of the patients had stage 2 (60-89 ml/min/1.73 m²), stage 3 (30-59), and stage 4 or higher (<30) CKD. Cure rates were similar for normal (91%) and stage 2 CKD (92%), but declined to 80% for stage 3 and to 75% for stage 4 CKD (p < 0.001 for trend). Time to resolution of diarrhea (TTROD) increased with stage 3 and stage 4 CKD. CDI recurrence rates 4 weeks after treatment were 16, 20, 27, and 24% for normal, stage 2, stage 3, and stage 4 or higher CKD, respectively. Mortality increased with CKD stage. In multivariate analyses, stage 3 or higher CKD correlated with lower odds of cure, greater chance of recurrence, and lower odds of sustained response 28 days after treatment. Initial cure rates were similar in the vancomycin or fidaxomicin groups; however, the rate of recurrence was higher following vancomycin treatment independent of renal function. The presence of immunosuppression did not alter this effect. Conclusion: Progressive CKD is associated with increased TTROD, lower cure rates, and higher recurrence rates with treatment of CDI.

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Section: Discussionmentioning

confidence: 99%

Renal Impairment and Clinical Outcomes of <i>Clostridium difficile</i> Infection in Two Randomized Trials

et al. 2013

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“…Vancomycin dose above 125 mg four times daily is not routinely recommended, recent reports suggesting no improvement in clinical cure, mortality or complications with increasing dose in severe disease . Reports of high serum vancomycin levels with 500 mg four times day dosing have also been noted in patients . Intravenous vancomycin therapy is not effective in CDI, however, colonic administration through an enema may be effective as an adjunctive therapy (uncertain dosing) if oral therapy is unable to be tolerated (500 mg in 100 mL normal saline, rectally 6 hourly) …”

Section: What Antibiotics Should Be Used For Treatment Of An Initial mentioning

confidence: 99%

“…69 Reports of high serum vancomycin levels with 500 mg four times day dosing have also been noted in patients. [70][71][72] Intravenous vancomycin therapy is not effective in CDI, however, colonic administration through an enema may be effective as an adjunctive therapy (uncertain dosing) if oral therapy is unable to be tolerated (500 mg in 100 mL normal saline, rectally 6 hourly). 4,[73][74][75] Recommendations 1.…”

Section: Dosing and Administrationmentioning

confidence: 99%

Australasian Society of Infectious Diseases updated guidelines for the management of Clostridium difficile infection in adults and children in Australia and New Zealand

Trubiano

Cheng

Korman

et al. 2016

Internal Medicine Journal

100

128

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The incidence of Clostridium difficile infection (CDI) continues to rise, whilst treatment remains problematic due to recurrent, refractory and potentially severe nature of disease. The treatment of C. difficile is a challenge for community and hospital-based clinicians. With the advent of an expanding therapeutic arsenal against C. difficile since the last published Australasian guidelines, an update on CDI treatment recommendations for Australasian clinicians was required. On behalf of the Australasian Society of Infectious Diseases, we present the updated guidelines for the management of CDI in adults and children.

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“…While renal impairment has been reported to be a risk factor for elevated serum VCM concentrations during enteral or oral administration in some cases (6, 7), it has also been reported that a patient with normal renal function developed significant absorption of oral VCM (5). Theoretically, renal impairment should be a risk factor in elevation of serum VCM concentration.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Fasting and Massive Diarrhea on Absorption of Enteral Vancomycin in Critically Ill Patients: A Retrospective Observational Study

et al. 2017

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PurposeAlthough vancomycin (VCM) is not absorbed from healthy intestinal mucosa, elevations in the serum VCM concentrations have been reported in some cases. The aims of this study are to evaluate the necessity of therapeutic drug monitoring (TDM) during enteral VCM administration in critically ill patients.Materials and methodsIn this retrospective study, we enrolled 19 patients admitted to our intensive care unit who were treated with enteral VCM from December 2006 to January 2014. Clinical factors were compared between two groups: Group E whose serum concentrations were detectable, and Group N whose concentrations were below the detection limit of the VCM assay.ResultsGroup E comprises 7 patients, and Group N comprises 12 patients. The fasting duration in Group E was significantly longer compared with that in Group N (17 vs. 8 days, p = 0.023). Furthermore, there was a significant correlation between the serum VCM concentrations and the fasting duration (r = 0.79, p < 0.0001), and the amount of diarrhea (r = 0.46, p = 0.046). No difference was observed in the amount of diarrhea at the time of TDM (Group E; 1,850 mL vs. Group N; 210 mL, p = 0.055) and in the Sequential Organ Failure Assessment subscore for the renal system at the time of TDM (Group E; 4.0 vs. Group N; 1.5, p = 0.068).ConclusionLong durations of fasting and massive diarrhea were associated with elevations in the serum VCM concentrations, which suggested that TDM might be necessary during enteral VCM administration in critically ill patients.Trial registrationUMIN Clinical Trials Registry identifier UMIN000016955.

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Oral vancomycin may have significant absorption in patients with Clostridium difficile colitis

Cited by 15 publications

References 10 publications

Renal Impairment and Clinical Outcomes of <i>Clostridium difficile</i> Infection in Two Randomized Trials

Renal Impairment and Clinical Outcomes of <i>Clostridium difficile</i> Infection in Two Randomized Trials

Australasian Society of Infectious Diseases updated guidelines for the management of Clostridium difficile infection in adults and children in Australia and New Zealand

The Effects of Fasting and Massive Diarrhea on Absorption of Enteral Vancomycin in Critically Ill Patients: A Retrospective Observational Study

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