Relapse of pseudomembranous colitis after vancomycin therapy

Limitations of presently available glycopeptides in the treatment of Gram-positive infection

The glycopeptide antibacterial drugs vancomycin and teicoplanin are widely used in hospitals for therapy of severe or multiresistant Gram-positive infections, notably staphylococcal, enterococcal and rarely pneumococcal. Vancomycin has also been used in the management of Clostridium difficile enteropathy. The incidence and potential for resistance differ between agents. The in vitro activity, pharmacokinetics and clinical use of glycopeptide, as well as epidemiology of glycopeptide resistance are discussed. There are limited comparative studies indicating the need for further investigation. Therapeutic drug monitoring has been widely used for vancomycin and less commonly for teicoplanin, but remains controversial. Advances in our understanding of their pharmacodynamics and clinical studies are helping clarify the situation. This paper reviews the current literature and highlights limitations of glycopeptides in treating Gram-positive infection.

Clostridium difficile colitis following treatment with metronidazole and vancomycin

A 25 year old woman developed Clostridium difficile colitis following a course of vancomycin and metronidazole prescribed for pelvic inflammatory disease. The condition resolved after treatment with vancomycin given alone. Colitis following this combination of antibiotics has not been described previously.

Pseudomembranous colitis

Nine patients with pseudomembranous colitis (PMC) are described. Eight patients received prior therapy with antibiotics. Pyrexia and polymorph leukocytosis were common features. Six relapses occurred in four of the six patients who were treated with vancomycin. Two patients who did not receive vancomycin died.

Relapse of antibiotic-associated colitis after vancomycin therapy

Antibiotic-associated colitis, although occasionally fatal, is a disease which is considered to be self-limiting and non-recurring. Recently, specific treatment with oral vancomycin directed at the trigger organism, Clostridium difficile, has been shown to be effective. A case in which antibiotic-associated colitis was treated with vancomycin and subsequently recurred is described. The fact that such relapse can occur indicates that further evaluation of the efficacy of vancomycin is required.