Comparison of two oral formulations of vancomycin for treatment of diarrhoea associated with <i>Clostridium difficile</i>

Baird, D. R.

doi:10.1093/jac/23.1.167

Cited by 27 publications

(12 citation statements)

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“…Many hospitals now reduce their acquisition costs by administering orally the generic formulation of intravenous vancomycin, which is 10-fold cheaper. Our results support this approach and document that the faecal levels obtained with the IV formulation are as high as those measured in patients who had received the Vancocin ® capsule in previous studies [20,21]. …”

Section: Discussionsupporting

confidence: 88%

“…Early pharmacokinetic studies used bioassays in which dilutions of faecal material were incubated with an assay organism ( Bacillus subtilis ) of known sensitivity [18-20]. Subsequent work used a fluorescence polarization immunoassay [21,22] but only one documented sequential measurements in a few patients [21]. Some used Vancocin ® capsules, while many hospitals now administer orally generic IV vancomycin.…”

Section: Introductionmentioning

confidence: 99%

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Faecal pharmacokinetics of orally administered vancomycin in patients with suspected Clostridium difficile infection

et al. 2010

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BackgroundOral vancomycin (125 mg qid) is recommended as treatment of severe Clostridium difficile infection (CDI). Higher doses (250 or 500 mg qid) are sometimes recommended for patients with very severe CDI, without supporting clinical evidence. We wished to determine to what extent faecal levels of vancomycin vary according to diarrhoea severity and dosage, and whether it is rational to administer high-dose vancomycin to selected patients.MethodsWe recruited hospitalized adults suspected to have CDI for whom oral vancomycin (125, 250 or 500 mg qid) had been initiated. Faeces were collected up to 3 times/day and levels were measured with the AxSYM fluorescence polarization immunoassay.ResultsFifteen patients (9 with confirmed CDI) were treated with oral vancomycin. Patients with ≥4 stools daily presented lower faecal vancomycin levels than those with a lower frequency. Higher doses of oral vancomycin (250 mg or 500 mg qid) led to consistently higher faecal levels (> 2000 mg/L), which were 3 orders of magnitude higher than the MIC90 of vancomycin against C. difficile. One patient receiving 125 mg qid had levels below 50 mg/L during the first day of treatment.ConclusionsFaecal levels of vancomycin are proportional to the dosage administered and, even in patients with increased stool frequency, much higher than the MIC90. Patients given the standard 125 mg qid dosage might have low faecal levels during the first day of treatment. A loading dose of 250 mg or 500 mg qid during the first 24-48 hours followed by the standard dosage should be evaluated in larger studies, since it might be less disruptive to the colonic flora and save unnecessary costs.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Faecal pharmacokinetics of orally administered vancomycin in patients with suspected Clostridium difficile infection

et al. 2010

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“…Furthermore, even a modest increase in the MIC of metronidazole for C. difficile might result in insufficient fecal antibiotic concentrations to inhibit (vegetative) bacteria. By contrast, oral vancomycin (125-250 mg every 6 h) administration generally yields fecal levels 11000 mg/L in patients with C. difficile infection [13]. Intravenously administered vancomycin does not result in sufficient intestinal concentrations and is not a therapeutic option.…”

mentioning

confidence: 99%

Editorial Commentary:Decreased Effectiveness of Metronidazole for the Treatment ofClostridium difficileInfection?

Kuijper

Wilcox

2008

CLIN INFECT DIS

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“…VCM is not absorbed through healthy intestinal mucosa (2–4); however, serum VCM concentrations were elevated due to renal dysfunction and intestinal mucosal damage with severe inflammation in the previous reports (5–8). As high concentrations of serum VCM lead to the adverse effects including renal dysfunction and ototoxicity (9, 10), therapeutic drug monitoring (TDM) is recommended in patients with renal failure during oral or enteral VCM administration (2).…”

Section: Introductionmentioning

confidence: 87%

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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Comparison of two oral formulations of vancomycin for treatment of diarrhoea associated with Clostridium difficile

Cited by 27 publications

References 0 publications

Faecal pharmacokinetics of orally administered vancomycin in patients with suspected Clostridium difficile infection

Faecal pharmacokinetics of orally administered vancomycin in patients with suspected Clostridium difficile infection

Editorial Commentary:Decreased Effectiveness of Metronidazole for the Treatment ofClostridium difficileInfection?

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

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