Vancomycin administered through the oral route is not usually absorbed from the intestinal mucosa into blood. However, serum vancomycin levels were elevated after oral administration in 2 patients with ileocolitis and renal dysfunction.
Case 1: A 61-year-old female developed severe sepsis after undergoing autologous peripheral blood stem cell transplantation for malignant lymphoma. She was orally administered 0.5 g of vancomycin for diarrhea associated with
Clostridium difficile infection every 6 hrs before ICU admission. In addition, she was intravenously administered 0.5 g of vancomycin twice per day for the prevention of methicillin-resistant
Staphylococcus aureus infection. The patient was admitted to the ICU, and continuous hemodiafiltration (CHDF) was started for renal dysfunction. Intravenous administration of vancomycin was stopped after serum vancomycin concentration reached 33.7μg/m
l (trough); subsequently, the serum vancomycin concentrations after 2 and 7 days were 43.5 and 45.0μg/m
l, respectively. After the discontinuation of oral administration, the serum concentration of vancomycin decreased gradually.
Case 2: A 63-year-old female who had taken prednisolone for idiopathic thrombocytopenic purpura and autoimmune hemolytic anemia was diagnosed with paralytic ileus and sepsis. She had developed severe diarrhea due to
Clostridium difficile infection. Further, she had renal dysfunction, for which CHDF was started. The patient was orally administered 0.5 g of vancomycin every 6 hrs; subsequently, the serum concentration of vancomycin after 10 days was 10.3μg/m
l. It can be assumed that vancomycin is absorbed from the intestinal mucosa and accumulates in the blood of these patients with ileocolitis and renal dysfunction. Hence, it is important to therapeutically monitor the serum vancomycin concentrations when administering the drug orally to patients with ileocolitis and renal dysfunction.
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