title: A Prospective Pilot Study on the Systemic Absorption of Oral Vancomycin in Children With Colitis.
abstract: BACKGROUND:Oral vancomycin is used to treat refractory colitis due to Clostridium dificile infection. Traditionally, oral vancomycin was thought to not be absorbed systemically, but recent adult studies have demonstrated detectable serum levels in over half of patients with severe colitis. This has not been studied in children.OBJECTIVE:To determine the absorption of oral vancomycin and the renal safety profile of oral vancomycin in children hospitalized with colitis.METHODS:We performed a prospective, observational, pilot proof of principle study at the North Carolina Children's Hospital in patients 2 years to 18 years of age receiving oral vancomycin for the treatment of C dificile colitis. Severity of disease was determined using a validated scoring system. Serial serum vancomycin levels and renal function tests were performed during the administration of oral vancomycin.RESULTS:All patients enrolled (n = 8) had mild to moderate C dificile colitis and varying severity of underlying systemic diseases; 7 with inflammatory bowel disease and 1 with acute kidney injury following renal transplantation. No enrolled patients had detectable levels of serum vancomycin. Additionally, no adverse renal outcomes were attributed to oral vancomycin, and no cases of "Red Man" syndrome were observed.CONCLUSIONS:Unlike studies in adult patients, oral vancomycin is likely not absorbed in children with mild to moderate colitis. Further study is needed to determine the pharmacokinetics in severe colitis and those with severe illness in a critical care setting.
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Children's Hospital, University of Illinois Hospital & Health Sciences System, Chicago, Illinois.
authors.forename: James W
authors.initials: JW
authors.lastname: Antoon
authors.affiliation: Divisions of General Pediatrics and Adolescent Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Margaret
authors.initials: M
authors.lastname: Hall
authors.affiliation: Division of General Pediatrics, Rush University Medical Center, Chicago, Illinois.
authors.forename: Diana
authors.initials: D
authors.lastname: Metropulos
authors.affiliation: Divisions of General Pediatrics and Adolescent Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Steiner
authors.affiliation: Pediatric Infectious Diseases, Department of Pediatrics, North Carolina Children's Hospital, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Ravi
authors.initials: R
authors.lastname: Jhaveri
authors.affiliation: Divisions of General Pediatrics and Adolescent Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Lohr
keywords: C dificile colitis; oral vancomycin; pediatric pharmacology; pharmacokinetics