An extremely high bioavailability of orally administered vancomycin in a patient with severe colitis and renal insufficiency

Shingo Yamazaki, Takaaki Suzuki, Tatsuya Suzuki, Hirokazu Takatsuka, Masayuki Ishikawa, Noriyuki Hattori, Takeshi Fujishiro, Hideaki Miyauchi, Takehiko Oami, Noritaka Ariyoshi, Shigeto Oda, Hisahiro Matsubara, Itsuko Ishii

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Because there is little absorption of orally administered vancomycin hydrochloride (VCM) through the normal intestinal microvillus membrane, the pharmacokinetics of VCM absorbed from the digestive tract are mostly unknown. Here we report a case of severe colitis and renal insufficiency in which the serum concentration of VCM reached the supratherapeutic range after oral administration. A 54-year-old man receiving outpatient chemotherapy for rectal cancer was admitted to our hospital for severe sepsis and acute renal failure. Multimodal therapy including continuous renal replacement therapy (CRRT) and mechanical ventilation was initiated, and oral VCM administration (0.5 g every 6 h) was begun for suspected severe pseudomembranous colitis with large amounts of watery stool. Despite continued CRRT, the serum VCM concentration increased to 30.6 μg/mL after 4 days. Based on pharmacokinetic analysis, the bioavailability of VCM was estimated to be over 54.5%. Colonoscopy showed that the mucosa was severely damaged throughout the large intestine, resulting in considerable exudation of plasma and blood. This case indicates the need for careful and early monitoring during high-dose oral VCM administration to patients with severe mucosal injury and renal insufficiency.

Original languageEnglish
JournalJournal of Infection and Chemotherapy
DOIs
Publication statusAccepted/In press - 2017
Externally publishedYes

Fingerprint

Colitis
Vancomycin
Biological Availability
Renal Insufficiency
Renal Replacement Therapy
Pharmacokinetics
Pseudomembranous Enterocolitis
Large Intestine
Colonoscopy
Rectal Neoplasms
Microvilli
Serum
Artificial Respiration
Acute Kidney Injury
Oral Administration
Gastrointestinal Tract
Sepsis
Mucous Membrane
Outpatients
Drug Therapy

Keywords

  • Bioavailability
  • Oral vancomycin
  • Pseudomembranous colitis
  • Renal insufficiency
  • Therapeutic drug monitoring

ASJC Scopus subject areas

  • Microbiology (medical)
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

An extremely high bioavailability of orally administered vancomycin in a patient with severe colitis and renal insufficiency. / Yamazaki, Shingo; Suzuki, Takaaki; Suzuki, Tatsuya; Takatsuka, Hirokazu; Ishikawa, Masayuki; Hattori, Noriyuki; Fujishiro, Takeshi; Miyauchi, Hideaki; Oami, Takehiko; Ariyoshi, Noritaka; Oda, Shigeto; Matsubara, Hisahiro; Ishii, Itsuko.

In: Journal of Infection and Chemotherapy, 2017.

Research output: Contribution to journalArticle

Yamazaki, S, Suzuki, T, Suzuki, T, Takatsuka, H, Ishikawa, M, Hattori, N, Fujishiro, T, Miyauchi, H, Oami, T, Ariyoshi, N, Oda, S, Matsubara, H & Ishii, I 2017, 'An extremely high bioavailability of orally administered vancomycin in a patient with severe colitis and renal insufficiency', Journal of Infection and Chemotherapy. https://doi.org/10.1016/j.jiac.2017.08.004
Yamazaki, Shingo ; Suzuki, Takaaki ; Suzuki, Tatsuya ; Takatsuka, Hirokazu ; Ishikawa, Masayuki ; Hattori, Noriyuki ; Fujishiro, Takeshi ; Miyauchi, Hideaki ; Oami, Takehiko ; Ariyoshi, Noritaka ; Oda, Shigeto ; Matsubara, Hisahiro ; Ishii, Itsuko. / An extremely high bioavailability of orally administered vancomycin in a patient with severe colitis and renal insufficiency. In: Journal of Infection and Chemotherapy. 2017.
@article{5b26b412cf7e439190bc0217d94ae2c7,
title = "An extremely high bioavailability of orally administered vancomycin in a patient with severe colitis and renal insufficiency",
abstract = "Because there is little absorption of orally administered vancomycin hydrochloride (VCM) through the normal intestinal microvillus membrane, the pharmacokinetics of VCM absorbed from the digestive tract are mostly unknown. Here we report a case of severe colitis and renal insufficiency in which the serum concentration of VCM reached the supratherapeutic range after oral administration. A 54-year-old man receiving outpatient chemotherapy for rectal cancer was admitted to our hospital for severe sepsis and acute renal failure. Multimodal therapy including continuous renal replacement therapy (CRRT) and mechanical ventilation was initiated, and oral VCM administration (0.5 g every 6 h) was begun for suspected severe pseudomembranous colitis with large amounts of watery stool. Despite continued CRRT, the serum VCM concentration increased to 30.6 μg/mL after 4 days. Based on pharmacokinetic analysis, the bioavailability of VCM was estimated to be over 54.5{\%}. Colonoscopy showed that the mucosa was severely damaged throughout the large intestine, resulting in considerable exudation of plasma and blood. This case indicates the need for careful and early monitoring during high-dose oral VCM administration to patients with severe mucosal injury and renal insufficiency.",
keywords = "Bioavailability, Oral vancomycin, Pseudomembranous colitis, Renal insufficiency, Therapeutic drug monitoring",
author = "Shingo Yamazaki and Takaaki Suzuki and Tatsuya Suzuki and Hirokazu Takatsuka and Masayuki Ishikawa and Noriyuki Hattori and Takeshi Fujishiro and Hideaki Miyauchi and Takehiko Oami and Noritaka Ariyoshi and Shigeto Oda and Hisahiro Matsubara and Itsuko Ishii",
year = "2017",
doi = "10.1016/j.jiac.2017.08.004",
language = "English",
journal = "Journal of Infection and Chemotherapy",
issn = "1341-321X",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - An extremely high bioavailability of orally administered vancomycin in a patient with severe colitis and renal insufficiency

AU - Yamazaki, Shingo

AU - Suzuki, Takaaki

AU - Suzuki, Tatsuya

AU - Takatsuka, Hirokazu

AU - Ishikawa, Masayuki

AU - Hattori, Noriyuki

AU - Fujishiro, Takeshi

AU - Miyauchi, Hideaki

AU - Oami, Takehiko

AU - Ariyoshi, Noritaka

AU - Oda, Shigeto

AU - Matsubara, Hisahiro

AU - Ishii, Itsuko

PY - 2017

Y1 - 2017

N2 - Because there is little absorption of orally administered vancomycin hydrochloride (VCM) through the normal intestinal microvillus membrane, the pharmacokinetics of VCM absorbed from the digestive tract are mostly unknown. Here we report a case of severe colitis and renal insufficiency in which the serum concentration of VCM reached the supratherapeutic range after oral administration. A 54-year-old man receiving outpatient chemotherapy for rectal cancer was admitted to our hospital for severe sepsis and acute renal failure. Multimodal therapy including continuous renal replacement therapy (CRRT) and mechanical ventilation was initiated, and oral VCM administration (0.5 g every 6 h) was begun for suspected severe pseudomembranous colitis with large amounts of watery stool. Despite continued CRRT, the serum VCM concentration increased to 30.6 μg/mL after 4 days. Based on pharmacokinetic analysis, the bioavailability of VCM was estimated to be over 54.5%. Colonoscopy showed that the mucosa was severely damaged throughout the large intestine, resulting in considerable exudation of plasma and blood. This case indicates the need for careful and early monitoring during high-dose oral VCM administration to patients with severe mucosal injury and renal insufficiency.

AB - Because there is little absorption of orally administered vancomycin hydrochloride (VCM) through the normal intestinal microvillus membrane, the pharmacokinetics of VCM absorbed from the digestive tract are mostly unknown. Here we report a case of severe colitis and renal insufficiency in which the serum concentration of VCM reached the supratherapeutic range after oral administration. A 54-year-old man receiving outpatient chemotherapy for rectal cancer was admitted to our hospital for severe sepsis and acute renal failure. Multimodal therapy including continuous renal replacement therapy (CRRT) and mechanical ventilation was initiated, and oral VCM administration (0.5 g every 6 h) was begun for suspected severe pseudomembranous colitis with large amounts of watery stool. Despite continued CRRT, the serum VCM concentration increased to 30.6 μg/mL after 4 days. Based on pharmacokinetic analysis, the bioavailability of VCM was estimated to be over 54.5%. Colonoscopy showed that the mucosa was severely damaged throughout the large intestine, resulting in considerable exudation of plasma and blood. This case indicates the need for careful and early monitoring during high-dose oral VCM administration to patients with severe mucosal injury and renal insufficiency.

KW - Bioavailability

KW - Oral vancomycin

KW - Pseudomembranous colitis

KW - Renal insufficiency

KW - Therapeutic drug monitoring

UR - http://www.scopus.com/inward/record.url?scp=85028853842&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85028853842&partnerID=8YFLogxK

U2 - 10.1016/j.jiac.2017.08.004

DO - 10.1016/j.jiac.2017.08.004

M3 - Article

JO - Journal of Infection and Chemotherapy

JF - Journal of Infection and Chemotherapy

SN - 1341-321X

ER -