Risk Factors for Systemic Vancomycin Exposure Following Administration of Oral Vancomycin for the Treatment of <i>Clostridium difficile</i>
 Infection

Pettit, Natasha N; DePestel, Daryl D.; Fohl, Alexander L.; Eyler, Rachel F.; Carver, Peggy L.

doi:10.1002/phar.1538

Cited by 42 publications

(41 citation statements)

References 29 publications

(89 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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%

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

128

View full text Add to dashboard Cite

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.

show abstract

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

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

128

View full text Add to dashboard Cite

show abstract

“…Therefore, this impairment might cause drug penetration through the intestinal mucosa. The plausibility of this hypothesis is supported by the report that ICU admission was a risk factor for serum VCM concentration elevations during enteral administration (12). In addition, tobramycin was detected in the blood during enteral tobramycin administration that was a component of the selective decontamination of the digestive tract in critically ill patients (25, 26).…”

Section: Discussionmentioning

confidence: 83%

“…We previously reported a critically ill patient with severe colitis and renal insufficiency presented elevated serum VCM concentrations above toxic levels during enteral VCM administration (11). Although the risk factors for elevated serum VCM concentrations have been suggested in the case series study (12), there is scarce evidence regarding the critically ill patients during oral or enteral VCM administration.…”

Section: Introductionmentioning

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

View full text Add to dashboard Cite

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.

show abstract

“…While recent adult data suggest that some systemic absorption of oral vancomycin is not uncommon in the setting of C. difficile colitis, the limited available pediatric data have not demonstrated absorption [13,14]. Nonetheless, the potential benefit of using gentamicin and/or vancomycin must be weighed against the risk of emerging resistant strains, such as vancomycin-resistant enterococci (VRE).…”

Section: Discussionmentioning

confidence: 99%

Oral Vancomycin and Gentamicin for Treatment of Very Early Onset Inflammatory Bowel Disease

Lev-Tzion

Ledder²,

Shteyer³

et al. 2017

Digestion

View full text Add to dashboard Cite

Background: The pathogenesis of inflammatory bowel disease (IBD) is complex and involves the contribution of genetic and environmental factors. Many patients with very early onset IBD are difficult to treat. The current antibiotic medication that targets gram-negative and anaerobic bacteria provides only moderate efficacy in subsets of patients with IBD. Methods: We report a case series of 5 children with a mean age of 1.6 years (range 6 months to 2.7 years) during IBD onset, who were previously refractory to standard treatments and who received oral vancomycin with or without gentamicin. Results: Four out of 5 children demonstrated substantial therapeutic effect, and the effect was sustained in 3 children over a follow-up period of 12-33 months. Conclusion: Our findings are consistent with model systems and suggest that randomized trials are required to establish whether a change in therapeutic paradigm, that is, targeting gram-positive bacteria with nonabsorbable antibiotics, may have therapeutic benefits.

show abstract

Risk Factors for Systemic Vancomycin Exposure Following Administration of Oral Vancomycin for the Treatment of Clostridium difficile Infection

Cited by 42 publications

References 29 publications

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

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

Oral Vancomycin and Gentamicin for Treatment of Very Early Onset Inflammatory Bowel Disease

Contact Info

Product

Resources

About