Oral Absorption of Enteral Vancomycin in a Child with Clostridium difficile Colitis and Renal Impairment

Abstract

Vancomycin is a glycopeptide antibiotic that is used by the enteral route for the treatment of Clostridium difficile infections and is not thought to be absorbed into the systemic circulation. We report on a 2-year-old, 12.5-kg patient with confirmed C difficile colitis and renal insufficiency that was treated with 125 mg of enteral vancomycin (10 mg/kg); the patient developed measurable systemic concentrations as high as 17.8 mg/L. However, as the patient's colitis began to improve, the serial vancomycin concentrations reflected little to no continued absorption of vancomycin. A review of the literature regarding this rare phenomenon is discussed.

Comparison of treatment of hypokalemia with oral administration of potassium chloride vial or oral tablets

“…Rifampin and ethambutol plasma concentrations were significantly low in HIV/ AIDS patients (13). In a case report, oral vancomycin had significantly higher absorption in a patient who had colitis (14), since one of our patients with inflammatory bowel disease, experienced severe abdominal pain three hours after taking oral potassium chloride tablets. Therefore, there are concerns about the oral intake of potassium chloride and that its absorption could be affected by underlying diseases and pathological conditions that can be fatal or ineffective.…”

South African Society of Clinical Microbiology Clostridioides difficile infection diagnosis, management and infection prevention and control guideline

“…For children with fulminant CDI, higher doses of vancomycin have been suggested (maximum 500 mg/dose) as theoretically severe colitis may result in systemic absorption and lower colonic luminal vancomycin levels. 136 At present, sufficient data are not available to recommend this approach. The optimal dose and volume of rectal vancomycin are not well established.…”