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

4 Citations (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

Keywords

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

ASJC Scopus subject areas

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

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  • Cite this

    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. (Accepted/In press). 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