Journal Article

Effect of Vancomycin on Intestinal Flora of Patients Who Previously Received Antimicrobial Therapy

Charlotta Edlund, Lisbeth Barkholt, Barbro Olsson-Liljequist and Carl Erik Nord

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 25, issue 3, pages 729-732
Published in print September 1997 | ISSN: 1058-4838
Published online September 1997 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/513755
Effect of Vancomycin on Intestinal Flora of Patients Who Previously Received Antimicrobial Therapy

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To evaluate the ecological disturbances of peroral vancomycin administration following cephalosporin administration, 20 healthy volunteers received cefuroxime axetil tablets (250 mg) perorally twice a day for 1 week, and 10 of these volunteers subsequently received vancomycin capsules (125 mg) perorally four times daily for 7 days. The concentration of vancomycin in feces after 1 week of vancomycin administration was high (mean ± SD, 520 ± 197 mg/kg), which correlated with the ecological disturbances noted in the vancomycin recipients. Vancomycin administration resulted in a rapid decrease in the numbers of intestinal Enterococcus faecium, Enterococcus faecalis, and Enterococcus durans (P ⩽ .05), while there was a significant emergence of motile enterococci with decreased susceptibility to vancomycin (Enterococcus gallinarum and Enterococcus casseliflavus; minimum inhibitory concentration, 4–16 mg/L) (P ⩽ .01). Because of vancomycin administration, there was also a significant overgrowth of vancomycin-resistant Pediococcus species and lactobacilli as well as of Klebsiella species, Citrobacter species, and Enterobacter species (P ⩽ .01). The numbers of bifidobacteria and Bacteroides species were significantly reduced during vancomycin administration. None of the enterococcal strains carried vanA or vanB. Twenty-two of the 27 motile enterococci carried the vanC-1 gene specific for E. gallinarum, whereas five strains carried the vanC-2(C-3) gene, thus implicating that they were E. casseliflavus or Enterococcus flavescens.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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