Systemic Absorption of Low-Dose Oral Vancomycin

Systemic absorption of oral vancomycin for the treatment of Clostridium difficile is thought to be trivial in patients without risk factors for increased systemic absorption and is often overlooked in clinical practice. A 51-year-old male elicits a suspected immunoglobulin E-mediated hypersensitivity following administration of low-dose oral vancomycin for the treatment of severe C difficile. The patient had normal renal function and was administered low doses of the medication, however, had a medical history significant for diverticulitis. Applying the Naranjo adverse drug reaction probability scale, a score of 5 was obtained, indicating a probable association between the administration of oral vancomycin and the hypersensitivity reaction. This case demonstrates that hypersensitivity reactions following low-dose oral vancomycin administration in patients with severe C difficile are possible, despite having normal renal function. Other risk factors for systemic absorption of oral vancomycin need to be evaluated in the literature, including severity of disease and underlying gastrointestinal processes.

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Oral Vancomycin-Induced Rash: Case Report and Review of the Literature

DICP ◽

10.1177/106002809102501207 ◽

1991 ◽

Vol 25 (12) ◽

pp. 1326-1328 ◽

Cited By ~ 8

Author(s):

Jill M. McCullough ◽

Debra G. Dielman ◽

Deborah Peery

Keyword(s):

Renal Failure ◽

Low Dose ◽

Maculopapular Rash ◽

Clear Correlation ◽

Serum Concentrations ◽

Oral Vancomycin ◽

Days Of Therapy ◽

Dose Oral ◽

Clostridium Difficile Colitis ◽

Clinically Significant

Disseminated rash and pruritus are described in an 82-year-old woman with chronic renal failure following administration of oral vancomycin hydrochloride 125 mg q6h for the treatment of Clostridium difficile colitis. Renal function was estimated to be 0.27 mL/s based on a serum creatinine of 177 μmol/L. After eight days of therapy, she developed a slightly raised maculopapular rash on her legs and torso, which spread to her abdomen and arms with continued treatment. Vancomycin was discontinued and the patient was treated symptomatically. The rash cleared and did not recur. Rechallenge with vancomycin was not initiated. No other changes in medications or initiations of new medications occurred during the time of treatment with vancomycin. The patient denied any previous immunologically mediated reactions to medications. Maculopapular rash is rare secondary to vancomycin administration, particularly after oral administration. Although clinically significant serum concentrations can be obtained in patients treated with oral vancomycin who have concomitant C. difficile colitis and renal failure, there has not been a clear correlation between these concentrations and any reported adverse sequelae. This case supports the possible occurrence of a true allergic reaction secondary to low-dose oral vancomycin administration.

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Effective Dosage of Oral Vancomycin in Treatment for Initial Episode of Clostridioides difficile Infection: A Systematic Review and Meta-Analysis

Antibiotics ◽

10.3390/antibiotics8040173 ◽

2019 ◽

Vol 8 (4) ◽

pp. 173 ◽

Cited By ~ 2

Author(s):

Chiu ◽

Sarwal ◽

Feinstein ◽

Hennessey

Keyword(s):

Low Dose ◽

Meta Analysis ◽

Effective Dosage ◽

Cochrane Library ◽

High Dose ◽

Oral Vancomycin ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection ◽

Dose Oral ◽

Initial Episode

Background: Oral vancomycin is a first line treatment for an initial episode of Clostridioides difficile infection. However, the comparative efficacy of different dosing regimens is lacking evidence in the current literature. Methods: We searched PubMed, Embase, Cochrane Library, and ClinicalTrials.gov. from inception to May 2019. Only articles published in English are reviewed. This meta-analysis compares the effects of low dose oral vancomycin (<2 g per day) versus high dose vancomycin (2 g per day) for treatment of initial Clostridioides difficile infection. Results: One randomized controlled trial and two retrospective cohort studies are included. A total of 137 patients are identified, 53 of which were treated with low dose oral vancomycin (39%) and 84 with high dose oral vancomycin (61%). There is no significant reduction in recurrence rates with high dose vancomycin compared to low dose vancomycin for treating initial episodes of non-fulminant Clostridioides difficile infection ((odds ratio (OR) 2.058, 95%, confidence interval (CI): 0.653 to 6.489). Conclusions: Based on limited data in the literature, low dose vancomycin is no different than high dose vancomycin for treatment of an initial episode of Clostridioides difficile infection in terms of recurrence rate. Additional large clinical trials comparing the different dosages of vancomycin in initial Clostridioides difficile infection are warranted.

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Use of a low-dose oral contraceptive containing norethindrone acetate and ethinyl estradiol in the treatment of moderate acne vulgaris

Clinical Journal of Women s Health ◽

10.1053/cjwh.2001.25638 ◽

2001 ◽

Vol 1 (3) ◽

pp. 123-131 ◽

Cited By ~ 16

Author(s):

J. Michael Maloney ◽

Deborah I. Arbit ◽

Mary Flack ◽

Constance McLaughlin-Miley ◽

Cynthia Sevilla ◽

...

Keyword(s):

Oral Contraceptive ◽

Low Dose ◽

Ethinyl Estradiol ◽

Acne Vulgaris ◽

Dose Oral ◽

Dose Oral Contraceptive ◽

Norethindrone Acetate

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Ongoing randomized clinical trials for the treatment of thrombosis in the antiphospholipid syndrome

Hämostaseologie ◽

10.1055/s-0037-1619507 ◽

2001 ◽

Vol 21 (02) ◽

pp. 77-81 ◽

Cited By ~ 2

Author(s):

G. Finazzi

Keyword(s):

Clinical Trials ◽

Large Scale ◽

Low Dose ◽

Randomized Clinical Trials ◽

Oral Anticoagulants ◽

Collaborative Study ◽

Clinical Problem ◽

Vascular Events ◽

Dose Oral ◽

Adverse Pregnancy

SummaryThrombotic events are a major clinical problem for patients with antiphospholipid antibodies (APA). However, current recommendations for their prevention and treatment are still based on retrospective studies. Data from large scale, prospective clinical trials are required to ultimately identify the optimal management of these patients. To date, at least four randomized studies are underway. The WAPS and PAPRE clinical trials are aimed to establish the correct duration and intensity of oral anticoagulation in APA patients with major arterial or venous thrombosis. The WARSS-APASS is a collaborative study to evaluate the efficacy and safety of aspirin or low-dose oral anticoagulants in preventing the recurrence of ischemic stroke. The recently announced UK Trial compares low-dose aspirin with or without low-intensity anticoagulation for the primary prevention of vascular events in APA-positive patients with SLE or adverse pregnancy history, but still thrombosis-free. It is hoped that the results of these trials will be available soon since clinicians urgently need more powerful data to treat their patients with the APA syndrome.

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Relationship Between Total Prothrombin, Native Prothrombin and the International Normalized Ratio (INR)

Thrombosis and Haemostasis ◽

10.1055/s-0038-1656342 ◽

1992 ◽

Vol 68 (02) ◽

pp. 160-164 ◽

Cited By ~ 3

Author(s):

P J Braun ◽

K M Szewczyk

Keyword(s):

Anticoagulant Therapy ◽

Oral Anticoagulant ◽

Inverse Relationship ◽

Low Dose ◽

Oral Anticoagulant Therapy ◽

International Normalized Ratio ◽

Antigen Assay ◽

Dose Oral ◽

Anticoagulated Patients ◽

Sensitive Method

SummaryPlasma levels of total prothrombin and fully-carboxylated (native) prothrombin were compared with results of prothrombin time (PT) assays for patients undergoing oral anticoagulant therapy. Mean concentrations of total and native prothrombin in non-anticoagulated patients were 119 ± 13 µg/ml and 118 ± 22 µg/ml, respectively. In anticoagulated patients, INR values ranged as high as 9, and levels of total prothrombin and native prothrombin decreased with increasing INR to minimum values of 40 µg/ml and 5 µg/ml, respectively. Des-carboxy-prothrombin increased with INR, to a maximum of 60 µg/ml. The strongest correlation was observed between native prothrombin and the reciprocal of the INR (1/INR) (r = 0.89, slope = 122 µg/ml, n = 200). These results indicated that native prothrombin varied over a wider range and was more closely related to INR values than either total or des-carboxy-prothrombin. Levels of native prothrombin were decreased 2-fold from normal levels at INR = 2, indicating that the native prothrombin antigen assay may be a sensitive method for monitoring low-dose oral anticoagulant therapy. The inverse relationship between concentration of native prothrombin and INR may help in identification of appropriate therapeutic ranges for oral anticoagulant therapy.

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