The Annals Visit the PharmaCE website!
home help contact us subscription past issues search current issue
QUICK SEARCH:   [advanced]


     


Published Online, 23 May 2006, www.theannals.com, DOI 10.1345/aph.1G668.
 The Annals of Pharmacotherapy: Vol. 40, No. 6, pp. 1186-1189. DOI 10.1345/aph.1G668
© 2006 Harvey Whitney Books Company.
This Article
Right arrow Résumé Freely available
Right arrow Extracto Freely available
Right arrow Full Text
Right arrow PDF
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Articles Ahead of Print
Right arrow [Order Reprint]
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Cadle, R. M
Right arrow Articles by Darouiche, R. O
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Cadle, R. M
Right arrow Articles by Darouiche, R. O

Vancomycin-Induced Elevation of Liver Enzyme Levels

Richard M Cadle, PharmD BCPS

Residency Program Director, Infectious Disease Clinical Pharmacy Specialist; Assistant Professor, Pharmacy Service and Section of Infectious Diseases, Michael E DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX

Mohammad D Mansouri, BS

Instructor, Department of Physical Medicine and Rehabilitation, Michael E DeBakey Veterans Affairs Medical Center and Baylor College of Medicine

Rabih O Darouiche, MD

Professor of Medicine, Section of Infectious Diseases, Michael E DeBakey Veterans Affairs Medical Center and Baylor College of Medicine

Reprints: Dr. Cadle, Pharmacy Service (119), Michael E DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX 77030-4211, fax 713/794-7064, cadle.richardmark{at}med.va.gov

OBJECTIVE: To report a case of oral vancomycin-induced elevation of liver enzyme levels.

CASE SUMMARY: A 57-year-old man with multiple medical conditions requiring systemic antibiotic therapy developed numerous Clostridium difficile-associated enterocolitis episodes. The patient did not respond adequately to oral metronidazole, as evidenced by his continuing diarrhea. He was treated with oral vancomycin on 5 separate occasions (with doses from 125 to 500 mg/day), each of which resulted in significant elevations in alanine aminotransferase (to 371 U/L) and aspartate aminotransferase (to 203 U/L) levels. The elevations resolved on each occasion with discontinuation of vancomycin.

DISCUSSION: Vancomycin, a glycopeptide antibiotic, has primary activity against gram-positive bacteria. Oral vancomycin can be used for the treatment of C. difficile-associated enterocolitis in patients who fail to respond to or are intolerant to metronidazole therapy. Oral vancomycin has very poor bioavailability and, as of May 4, 2006, has not been associated with hepatic toxicity. Inflammatory bowel disease processes can result in increased absorption of oral vancomycin.

CONCLUSIONS: This is the first reported case of oral vancomycin-induced elevation of hepatic enzyme levels. Use of the Naranjo probability scale indicated that this was a probable adverse drug-associated event.

Key Words: bioavailability, liver enzymes, vancomycin

Published Online, May 23, 2006. www.theannals.com, DOI 10.1345/aph.1G668




homecopy help contact us subscription past issues search current issue
Copyright © 2006 by Harvey Whitney Books Company.