Rash induced by enteral vancomycin therapy in an older patient in a long-term care ventilator unit: case report and review of the literature

Abstract

BackgroundOral vancomycin is a first-line treatment for severe Clostridium difficile colitis. Oral vancomycin is perceived to lack systemic absorption or systemic adverse effects; however, a few cases of hypersensitivity to oral vancomycin have been reported, all in hospitalized patients.Case presentationIn the present case, a 66-year-old woman with end-stage neurodegenerative disease residing in a long-term care facility developed a maculopapular rash following treatment with enteral vancomycin for recurrent C. difficile colitis. The rash resolved after withdrawal of the drug.ConclusionRashes associated with oral vancomycin treatment include maculopapular rash, urticaria, red man syndrome, and linear IgA bullous dermatitis. Risk factors for systemic vancomycin absorption include renal insufficiency, severe intestinal inflammation, and high vancomycin dose and duration. Routine serum testing of vancomycin levels, even in these high risk cases, is not recommended. Clinicians should be aware that enteral vancomycin can cause hypersensitivity reactions which may be serious.

A rare case of infant eosinophilia induced by oral vancomycin: a case report and literature review

“…A previous study reported that the risk factors of the systemic absorption of oral vancomycin included renal insufficiency, severe C. difficile infection, high vancomycin dose (>500 mg/day), long-term treatment (>10 days), intensive care unit admission, use of vancomycin retention enema and gastrointestinal inflammation. 32 All 16 patients described in this summary of the published literature had underlying diseases, which was basically consistent with the aforementioned research. Fortunately, except for one patient with serious underlying diseases and a poor prognosis after taking vancomycin orally for a long period of time, 25 all of the other 15 patients achieved good outcomes after stopping vancomycin and/or receiving other treatments.…”

“…Fortunately, except for one patient with serious underlying diseases and a poor prognosis after taking vancomycin orally for a long period of time, 25 all of the other 15 patients achieved good outcomes after stopping vancomycin and/or receiving other treatments. 11,16,19,20,23,24,27–34…”

“…26 The main clinical manifestations of IgE-mediated hypersensitivity induced by oral vancomycin are local or systemic maculopapule and urticaria. 26 Table 1 and Table 2 present a summary and analysis of the case reports (including this current case) of the adverse reactions caused by oral vancomycin, 11,16,19,20,[23][24][25][27][28][29][30][31][32][33][34] which can occur at ages ranging from 2 months to 82 years (median age, 59 years). Skin changes were the most common (13 of 16 patients; 81.3%).…”

“…Fortunately, except for one patient with serious underlying diseases and a poor prognosis after taking vancomycin orally for a long period of time, 25 all of the other 15 patients achieved good outcomes after stopping vancomycin and/or receiving other treatments. 11,16,19,20,23,24,[27][28][29][30][31][32][33][34] The effects of vancomycin on the haematological system include anaemia, leukopenia, thrombocytopenia and eosinophilia. However, there are few cases of eosinophilia caused by vancomycin in both the clinic and the published literature.…”

Effective Dosage of Oral Vancomycin in Treatment for Initial Episode of Clostridioides difficile Infection: A Systematic Review and Meta-Analysis

“…Red man syndrome, renal toxicity, and ototoxicity in oral vancomycin are controversial [26][27][28][29]. Detectable serum concentrations of vancomycin were noted after oral administration in dialysis patients, and impaired gastrointestinal mucosa in a stem cell transplant patient [27,30].…”