Faecal pharmacokinetics of orally administered vancomycin in patients with suspected Clostridium difficile infection

BMC Infectious Diseases

Research Article

Julie C Carrier¹  Jacques Pepin²  Milagros Gonzales²  Eric H Frost²  Louis Valiquette²  Stephanie Sirard²  Louis-Charles Fortier² 

[1] Department of Medicine, Université de Sherbrooke, 3001 12ème Avenue Nord, J1 H 5N4, Sherbrooke, Quebec, Canada;Department of Microbiology and Infectious Diseases, Université de Sherbrooke, 3001 12ème Avenue Nord, J1 H 5N4, Sherbrooke, Quebec, Canada;

关键词: Vancomycin;    Clostridium Difficile Infection;    Stool Frequency;    Oral Vancomycin;    Severe Clostridium Difficile Infection;   

DOI  :  10.1186/1471-2334-10-363

 received in 2010-06-21, accepted in 2010-12-30,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundOral vancomycin (125 mg qid) is recommended as treatment of severe Clostridium difficile infection (CDI). Higher doses (250 or 500 mg qid) are sometimes recommended for patients with very severe CDI, without supporting clinical evidence. We wished to determine to what extent faecal levels of vancomycin vary according to diarrhoea severity and dosage, and whether it is rational to administer high-dose vancomycin to selected patients.MethodsWe recruited hospitalized adults suspected to have CDI for whom oral vancomycin (125, 250 or 500 mg qid) had been initiated. Faeces were collected up to 3 times/day and levels were measured with the AxSYM fluorescence polarization immunoassay.ResultsFifteen patients (9 with confirmed CDI) were treated with oral vancomycin. Patients with ≥4 stools daily presented lower faecal vancomycin levels than those with a lower frequency. Higher doses of oral vancomycin (250 mg or 500 mg qid) led to consistently higher faecal levels (> 2000 mg/L), which were 3 orders of magnitude higher than the MIC90 of vancomycin against C. difficile. One patient receiving 125 mg qid had levels below 50 mg/L during the first day of treatment.ConclusionsFaecal levels of vancomycin are proportional to the dosage administered and, even in patients with increased stool frequency, much higher than the MIC90. Patients given the standard 125 mg qid dosage might have low faecal levels during the first day of treatment. A loading dose of 250 mg or 500 mg qid during the first 24-48 hours followed by the standard dosage should be evaluated in larger studies, since it might be less disruptive to the colonic flora and save unnecessary costs.

【 授权许可】

Unknown   
© Gonzales et al; licensee BioMed Central Ltd. 2010. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.