ArticleBMC infectious diseases2010
Faecal pharmacokinetics of orally administered vancomycin in patients with suspected Clostridium difficile infection.
Article in BMC infectious diseases, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 55 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
55 citing papers in PubMed, 2 syntheses or guidelines pooled it, 137 citations in OpenAlex.
- Optimal therapeutic recommendation for Clostridioides difficile infection in pediatric and adolescent populations: a systematic review and meta-analysis.European journal of pediatrics · 2023Pooled it
- Omadacycline andThe Annals of pharmacotherapy · 2023Pooled it
- Fecal Pharmacokinetics and Gut Microbiome Effects of Oral Omadacycline Versus Vancomycin in Healthy Volunteers.The Journal of infectious diseases · 2024Trial
- Understanding Pharmacokinetic Variability of Pomalidomide: A Physiologically Based Pharmacokinetic Analysis of Disease-Related Physiology, Ethnicity, Hepatic Impairment, Food Effects, Drug Interactions, and Smoking.Clinical pharmacokinetics · 2026Article
- Article
- Evaluation of the antibacterial activity of the natural product α-mangostin against Clostridioides difficile.PloS one · 2026Article
- Evaluating Effects of Antibiotics Across Preclinical Models of the Human Gastrointestinal Microbiota.MicrobiologyOpen · 2025Article
- Vancomycin-resistant enterococci utilise antibiotic-enriched nutrients for intestinal colonisation.Nature communications · 2025Article
- High-resolution fecal pharmacokinetic modeling in mice with orally administered antibiotics.Scientific reports · 2025Article
- Baicalein and Berberine Inhibit the Growth and Virulence ofPathogens (Basel, Switzerland) · 2025Article
- A Review of Therapies forAntibiotics (Basel, Switzerland) · 2024Review
- Adaptation mechanisms of Clostridioides difficile to auranofin and its impact on human gut microbiota.NPJ biofilms and microbiomes · 2024Article
- Reduced Vancomycin Susceptibility in Clostridioides difficile Is Associated With Lower Rates of Initial Cure and Sustained Clinical Response.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Article
- Review
- Genetic determinants of resistance to antimicrobial therapeutics are rare in publicly available Clostridioides difficile genome sequences.The Journal of antimicrobial chemotherapy · 2024Article
- ImprovingAntibiotics (Basel, Switzerland) · 2024Article
- Antibiotic-mediated dysbiosis leads to activation of inflammatory pathways.Frontiers in immunology · 2024Article
- Effectiveness of oral vancomycin as prophylaxis againstAntimicrobial stewardship & healthcare epidemiology : ASHE · 2024Article
- When less is more: shortening the Lpp protein leads to increased vancomycin resistance in Escherichia coli.The Journal of antibiotics · 2023Article
- Omadacycline compared to vancomycin when combined with germinants to disrupt the life cycle ofAntimicrobial agents and chemotherapy · 2023Article
Corrections and comments
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundOral vancomycin (125 mg qid) is recommended as treatment of severe Clostridium difficile infection (CDI). Higher doses (250 or 500 mg qid) are sometimes recommended for patients with very severe CDI, without supporting clinical evidence. We wished to determine to what extent faecal levels of vancomycin vary according to diarrhoea severity and dosage, and whether it is rational to administer high-dose vancomycin to selected patients.
methodsWe recruited hospitalized adults suspected to have CDI for whom oral vancomycin (125, 250 or 500 mg qid) had been initiated. Faeces were collected up to 3 times/day and levels were measured with the AxSYM fluorescence polarization immunoassay.
resultsFifteen patients (9 with confirmed CDI) were treated with oral vancomycin. Patients with ≥ 4 stools daily presented lower faecal vancomycin levels than those with a lower frequency. Higher doses of oral vancomycin (250 mg or 500 mg qid) led to consistently higher faecal levels (> 2000 mg/L), which were 3 orders of magnitude higher than the MIC90 of vancomycin against C. difficile. One patient receiving 125 mg qid had levels below 50 mg/L during the first day of treatment.
conclusionsFaecal levels of vancomycin are proportional to the dosage administered and, even in patients with increased stool frequency, much higher than the MIC90. Patients given the standard 125 mg qid dosage might have low faecal levels during the first day of treatment. A loading dose of 250 mg or 500 mg qid during the first 24-48 hours followed by the standard dosage should be evaluated in larger studies, since it might be less disruptive to the colonic flora and save unnecessary costs.
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