The effect of oral vancomycin on chronic idiopathic constipation.
BACKGROUND
A case study reporting the efficacy of oral vancomycin in a patient with chronic idiopathic constipation prompted this prospective trial of oral vancomycin in eight female patients (aged 21-61 years) with severe constipation resistant to the action of dietary fibre.


METHODS
The trial was divided into two consecutive 14-day periods. During the first period, each patient was given ispaghula, 3.5 g twice a day, and during the subsequent period they took 250 mg vancomycin t.d.s. per os, as well as the fibre supplement. During both periods they collected stools and recorded daily bowel symptoms (stool frequency, straining, stool consistency, subjective stool volume) in a diary. At the end of each period whole gut transit time and the breath hydrogen response to a standard meal, giving oro-caecal transit time, were measured along with gastrointestinal symptoms which were assessed on visual analogue scales.


RESULTS
Vancomycin caused a significant improvement in stool frequency, consistency, ease of defecation and the amount of stool patients felt they produced (all P < 0.05), but objective measures of daily stool weight and whole gut or oro-caecal transit time were not significantly different. Basal breath hydrogen levels were higher after vancomycin treatment in seven out of eight patients. One patient experienced a complete remission of symptoms when she took vancomycin and remains in remission after 14 months. This patient showed no elevation in basal breath hydrogen level.


CONCLUSIONS
Although this study does not support the use of vancomycin for most patients with constipation, the results suggest that modification of the intraluminal flora may be of value in the treatment of the occasional case of idiopathic constipation.
Celik
A F
AF
Gastrointestinal Motility Unit, University of Sheffield, UK.
Tomlin
J
J
Read
N W
NW
D000284:Administration, Oral; D000328:Adult; D001944:Breath Tests; D002951:Citrates / Q000008:administration & dosage / Q000627:therapeutic use; D019343:Citric Acid; D003248:Constipation / Q000188:drug therapy*; D003672:Defecation / Q000187:drug effects*; D004043:Dietary Fiber / Q000008:administration & dosage / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D005772:Gastrointestinal Transit / Q000187:drug effects; D006801:Humans; D008875:Middle Aged; D010936:Plant Extracts / Q000008:administration & dosage / Q000627:therapeutic use; D017693:Sodium Bicarbonate / Q000008:administration & dosage / Q000627:therapeutic use; D014640:Vancomycin / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology / Q000627:therapeutic use*
D002951:Citrates; D004043:Dietary Fiber; D004338:Drug Combinations; D010936:Plant Extracts; D019343:Citric Acid; D014640:Vancomycin; C018299:citric acid, ispaghula husk, sodium bicarbonate drug combination; D017693:Sodium Bicarbonate