Successful response of primary sclerosing cholangitis and associated ulcerative colitis to oral vancomycin may depend on brand and personalized dose: report in an adolescent

Cynthia W. Buness, Kevin M. Johnson, Ahmad Hassan Ali, Leina Alrabadi, Keith D. Lindor, Tamir Miloh, Kenneth L. Cox

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Primary sclerosing cholangitis (PSC) is a rare, progressive liver disease characterized by cholestasis and bile duct fibrosis that has no accepted therapy known to delay or arrest its progression. We report a 23-year-old female patient who at age 14 was diagnosed with moderate pancolonic ulcerative colitis (UC) and at age 15 with small-duct PSC unresponsive to conventional therapy. The patient began single drug therapy with the antibiotic oral vancomycin (OVT) and achieved normalization of liver enzymes and resolution of UC symptoms with colonic mucosal healing. These improvements have persisted over 8 years. There has been no colon dysplasia, liver fibrosis or failure, bile duct stricture, or cancer. Of note, the patient’s response was dependent on the brand of oral vancomycin capsule, as well as dose. This raised the questions of possible differences in bioequivalence of different commercial versions of the drug and whether this factor might play into the variability of efficacy seen in published trials. Evidence suggests that oral vancomycin both alters the intestinal microbiome and has immunomodulatory effects. Its striking effectiveness in this and other patients supports further investigation in randomized trials, with careful attention to its bioavailability profile in the gut.

Original languageEnglish (US)
Pages (from-to)684-689
Number of pages6
JournalClinical Journal of Gastroenterology
Volume14
Issue number2
DOIs
StatePublished - Apr 2021

Keywords

  • Bioequivalence
  • Microbiome
  • Primary sclerosing cholangitis
  • Ulcerative colitis
  • Vancomycin

ASJC Scopus subject areas

  • Gastroenterology

Fingerprint

Dive into the research topics of 'Successful response of primary sclerosing cholangitis and associated ulcerative colitis to oral vancomycin may depend on brand and personalized dose: report in an adolescent'. Together they form a unique fingerprint.

Cite this