Oral Absorption of Enteral Vancomycin in a Child with Clostridium difficile Colitis and Renal Impairment

Vancomycin is a glycopeptide antibiotic that is used by the enteral route for the treatment of Clostridium difficile infections and is not thought to be absorbed into the systemic circulation. We report on a 2-year-old, 12.5-kg patient with confirmed C difficile colitis and renal insufficiency that was treated with 125 mg of enteral vancomycin (10 mg/kg); the patient developed measurable systemic concentrations as high as 17.8 mg/L. However, as the patient's colitis began to improve, the serial vancomycin concentrations reflected little to no continued absorption of vancomycin. A review of the literature regarding this rare phenomenon is discussed.