A prospective pilot study on the systemic absorption of oral vancomycin in children with colitis

James W. Antoon*, Margaret Hall, Diana Metropulos, J. Steiner, Ravi Ramesh Jhaveri, Jacob A. Lohr

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


BACKGROUND: Oral vancomycin is used to treat refractory colitis due to Clostridium difficile infection. Traditionally, oral vancomycin was thought to not be absorbed systemically, but recent adult studies have demonstrated detectable serum levels in over half of patients with severe colitis. This has not been studied in children. OBJECTIVE: To determine the absorption of oral vancomycin and the renal safety profile of oral vancomycin in children hospitalized with colitis. METHODS: We performed a prospective, observational, pilot proof of principle study at the North Carolina Children’s Hospital in patients 2 years to 18 years of age receiving oral vancomycin for the treatment of C difficile colitis. Severity of disease was determined using a validated scoring system. Serial serum vancomycin levels and renal function tests were performed during the administration of oral vancomycin. RESULTS: All patients enrolled (n = 8) had mild to moderate C difficile colitis and varying severity of underlying systemic diseases; 7 with inflammatory bowel disease and 1 with acute kidney injury following renal transplantation. No enrolled patients had detectable levels of serum vancomycin. Additionally, no adverse renal outcomes were attributed to oral vancomycin, and no cases of “Red Man” syndrome were observed. CONCLUSIONS: Unlike studies in adult patients, oral vancomycin is likely not absorbed in children with mild to moderate colitis. Further study is needed to determine the pharmacokinetics in severe colitis and those with severe illness in a critical care setting.

Original languageEnglish (US)
Pages (from-to)426-431
Number of pages6
JournalJournal of Pediatric Pharmacology and Therapeutics
Issue number5
StatePublished - Sep 1 2016


  • C difficile colitis
  • Oral vancomycin
  • Pediatric pharmacology
  • Pharmacokinetics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pharmacology (medical)

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