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

Autor: Takaaki Suzuki, Itsuko Ishii, Hirokazu Takatsuka, Shingo Yamazaki, Hideaki Miyauchi, Noriyuki Hattori, Tatsuya Suzuki, Masayuki Ishikawa, Takeshi Fujishiro, Hisahiro Matsubara, Shigeto Oda, Takehiko Oami, Noritaka Ariyoshi
Rok vydání: 2017
Předmět:
0301 basic medicine
Microbiology (medical)
Male
medicine.medical_specialty
medicine.medical_treatment
030106 microbiology
Administration
Oral
Biological Availability
Antineoplastic Agents
030226 pharmacology & pharmacy
Gastroenterology
Microvillus membrane
03 medical and health sciences
0302 clinical medicine
Pharmacokinetics
Oral administration
Vancomycin
Internal medicine
Sepsis
medicine
Humans
Pharmacology (medical)
Large intestine
Renal replacement therapy
Intestine
Large
Enterocolitis
Pseudomembranous
medicine.diagnostic_test
business.industry
Rectal Neoplasms
Pseudomembranous colitis
Colonoscopy
Acute Kidney Injury
Middle Aged
Respiration
Artificial
Surgery
Anti-Bacterial Agents
Renal Replacement Therapy
Infectious Diseases
medicine.anatomical_structure
Therapeutic drug monitoring
business
medicine.drug
Zdroj: Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy. 23(12)
ISSN: 1437-7780
Popis: 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.
Databáze: OpenAIRE
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