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 language | English |
|---|---|
| Journal | Journal of Infection and Chemotherapy |
| DOIs | |
| Publication status | Accepted/In press - 2017 |
| Externally published | Yes |
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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 journal › Article
}
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
C2 - 28923303
AN - SCOPUS:85028853842
JO - Journal of Infection and Chemotherapy
JF - Journal of Infection and Chemotherapy
SN - 1341-321X
ER -