title: Systemic absorption of oral vancomycin in a peripheral blood stem cell transplant patient with severe graft-versus-host disease of the gastrointestinal tract.
abstract: Oral vancomycin is often considered the drug of choice for severe Clostridium difficile-associated disease due to both its efficacy and pharmacokinetics. The potential for absorption is not well described in patients with impaired gastrointestinal (GI) mucosa. We describe a case of significant and potentially toxic absorption of oral vancomycin in a peripheral blood stem cell transplant patient with grade IV graft-versus-host disease (GVHD) of the GI tract. In patients with GI GVHD clinicians need to be aware of the potential for oral absorption and, in select cases, monitoring of levels may be appropriate.
authors.affiliation: Department of Pharmacy Services, Sinai Grace Hospital, Detroit Medical Center, Detroit, Michigan 48235-2624, USA. jpogue@dmc.org
authors.forename: J M
authors.initials: JM
authors.lastname: Pogue
authors.forename: D D
authors.initials: DD
authors.lastname: DePestel
authors.forename: D R
authors.initials: DR
authors.lastname: Kaul
authors.forename: Y
authors.initials: Y
authors.lastname: Khaled
authors.forename: D G
authors.initials: DG
authors.lastname: Frame
mesh_terms: D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D016360:Clostridioides difficile / Q000187:drug effects; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy* / Q000382:microbiology; D005767:Gastrointestinal Diseases / Q000188:drug therapy; D041981:Gastrointestinal Tract / Q000276:immunology / Q000382:microbiology; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007408:Intestinal Absorption / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects*; D014640:Vancomycin / Q000008:administration & dosage / Q000493:pharmacokinetics*
chemical_list: D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; D014640:Vancomycin