Unexpected serum level of vancomycin after oral administration in a patient with severe colitis and renal insufficiency.
OBJECTIVE
To report a case in which the serum concentration of vancomycin (VCM) reached the supratherapeutic range following oral administration in a patient with severe pseudomembranous colitis and renal insufficiency.


METHODS
A 65-year-old, 70 kg weighing man with severe acute pancreatitis and acute renal failure was subjected to continuous hemodiafiltration (CHDF). CHDF could only be performed intermittently because of the unstable circulation dynamic of this patient. After admission, intravenous VCM therapy was initiated. Thereafter, oral VCM administration was begun (0.5 g every 6 h). Despite the discontinuation of intravenous VCM after the first 2 days of oral VCM, the serum VCM concentration increased gradually to 49.8 mg/l over a period of 2 weeks from the initiation of oral administration (34.4 mg/l). Based on pharmacokinetic analysis, the bioavailability of VCM was estimated to over 33%. Autopsy findings indicated broadly distributed necrosis on the lamina propria of the mucosa throughout all parts of the intestine below the duodenum.


CONCLUSIONS
This case indicates necessity of the careful monitoring after oral high-dose VCM administration in a patient with a broadly distributed necrosis and renal insufficiency.


CONCLUSIONS
TDM should be considered according to renal function, the severity of enteritis and the total dosage of oral VCM administration.
Chiba University Hospital, Chiba University School of Medicine, Japan. s-yamazaki@ho.chiba-u.ac.jp
S
S
Yamazaki
H
H
Nakamura
S
S
Yamagata
G
G
Miura
N
N
Hattori
K
K
Shinozaki
T
T
Sadahiro
A
A
Toyoda
H
H
Nakasa
N
N
Ariyoshi
S
S
Oda
K
K
Harigaya
M
M
Kitada
D000208:Acute Disease; D058186:Acute Kidney Injury / Q000150:complications* / Q000503:physiopathology; D000284:Administration, Oral; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics*; D001682:Biological Availability; D016903:Drug Monitoring; D004761:Enterocolitis, Pseudomembranous / Q000150:complications* / Q000503:physiopathology; D017583:Hemodiafiltration / Q000379:methods; D006801:Humans; D008297:Male; D009336:Necrosis / Q000503:physiopathology; D019512:Pancreatitis, Alcoholic / Q000150:complications; D012720:Severity of Illness Index; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics*
D000900:Anti-Bacterial Agents; D014640:Vancomycin