Elevated Serum Vancomycin Concentrations After Oral Administration in a Hemodialysis Patient with Pseudomembranous Colitis
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概要
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We present a 68-year-old male case, hemodialysis patient (body weight 56.8 kg) with <I>Clostridium difficile (C. difficile</I>) induced pseudomembranous colitis. The colitis was treated with orally administered vancomycin (VCM), 2.0 g/day, for 14 days leading to high serum levels. At this time, the VCM treatment was discontinued following negative stool cultures for <I>C. difficile</I>, and the serum VCM concentration was 58.7 μg/ml, the highest level in oral VCM case reports up to the present. Mean bioavailability was estimated as 16.8% during the VCM administration period in this patient, and it was assumed that the intestinal absorption of VCM was increased with severe colitis. As the serum VCM levels continued to decrease gradually, the symptoms of colitis improved. Nevertheless, the patient's colitis relapsed after oral levofloxacin treatment for bronchitis and high fever, although the serum VCM levels were still far greater than the minimum inhibitory concentration of <I>C. difficile</I> infection.<BR>This finding suggests that VCM concentrations may remain insufficient in the colon despite the high serum levels. The high and persistent serum VCM concentrations in this patient may be due to the follow-ing: 1. increased absorption of VCM with severe colitis, 2. decreased excretion with renal impairment leading to VCM serum accumulation, and 3. too high a VCM dosage. We conclude that patients with both renal failure and severe intestinal disease may absorb and accumulate significant amounts of orally administered VCM. Therefore, a high dose oral VCM should be avoided in hemodialysis patients with severe pseudomembranous colitis.
- 一般社団法人 日本臨床薬理学会の論文
著者
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Izumi Satoshi
Department Of Cardiovascular Surgery Kochi Red Cross Hospital
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Hirata Sumio
Department Of Clinical Pharmacology Graduate School Of Pharmaceutical Sciences Kumamoto University
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Yamakawa Tomoyuki
Department Of Anesthesia Kyoto City Hospital
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OKUNO Senji
Department of Medicine, Shirasagi Hospital
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MATOBA Mami
Department of Pharmacy Service, Shirasagi Hospital
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FURUKUBO Taku
Department of Pharmacy Service, Shirasagi Hospital
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OTA Miyuki
Department of Pharmacy Service, Shirasagi Hospital
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FUJITA Minori
Department of Pharmacy Service, Shirasagi Hospital
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HIRATA Sumio
Department of Pharmacy Service, Shirasagi Hospital
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YAMAKAWA Tomoyuki
Department of Medicine, Shirasagi Hospital
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IZUMI Satoshi
Department of Pharmacy Service, Shirasagi Hospital
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