Guest guest Posted September 12, 2006 Report Share Posted September 12, 2006 i can speak to this as my son is in dr. cox's vanco study at lpch in palo alto. travis was diagnosed with psc in feb. with severe portal hypertension and cirrhosis. we started him on the vanco in march and his enzymes have continued to fall. last month his numbers did not go down as much as hoped le so we are looking for better results the end of this month. he has been listed for tx with a current inactive status. most of the children with psc without cirrhosis have done well. the latest study will be published shortly. the vanco has been our only hope and so far it has kept travis out of transplant. my son was 6 months from total liver failure with no overt sx's. the portal hypertension was discovered incidently during a routine endoscoopy for his reflex disease. he does not have uc. he is 16 years old and has always been very healthy. it was a complete surprise. dr. cox and his team have been great! rita -------------- Original message -------------- Dear All;I'd like to initiate a discussion about this rather obscure paper:J Pediatr Gastroenterol Nutr. 1998 Nov;27(5):580-3. Oral vancomycin: treatment of primary sclerosing cholangitis in children with inflammatory bowel disease. KL, KMDepartment of Pediatrics, Lucile Salter Packard Children's Hospital at Stanford University, Palo Alto, California 94304, USA.PMID: 9822326You can access the full text at:www.jpgn.org/pt/re/jpgn/fulltext.00005176-199811000-00015.htmThe paper describes "three children with sclerosing cholangitis and inflammatory bowel disease whose liver tests and symptoms improved when treated with oral vancomycin".As I understand it, Dr. is currently treating a larger number of patients with this antibiotic. Is anyone in this group enrolled in this study, and if so, are they willing to comment about it?Many tha nks,Best regards,Dave (father of (21); PSC 07/03; UC 08/03) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 12, 2006 Report Share Posted September 12, 2006 i can speak to this as my son is in dr. cox's vanco study at lpch in palo alto. travis was diagnosed with psc in feb. with severe portal hypertension and cirrhosis. we started him on the vanco in march and his enzymes have continued to fall. last month his numbers did not go down as much as hoped le so we are looking for better results the end of this month. he has been listed for tx with a current inactive status. most of the children with psc without cirrhosis have done well. the latest study will be published shortly. the vanco has been our only hope and so far it has kept travis out of transplant. my son was 6 months from total liver failure with no overt sx's. the portal hypertension was discovered incidently during a routine endoscoopy for his reflex disease. he does not have uc. he is 16 years old and has always been very healthy. it was a complete surprise. dr. cox and his team have been great! rita -------------- Original message -------------- Dear All;I'd like to initiate a discussion about this rather obscure paper:J Pediatr Gastroenterol Nutr. 1998 Nov;27(5):580-3. Oral vancomycin: treatment of primary sclerosing cholangitis in children with inflammatory bowel disease. KL, KMDepartment of Pediatrics, Lucile Salter Packard Children's Hospital at Stanford University, Palo Alto, California 94304, USA.PMID: 9822326You can access the full text at:www.jpgn.org/pt/re/jpgn/fulltext.00005176-199811000-00015.htmThe paper describes "three children with sclerosing cholangitis and inflammatory bowel disease whose liver tests and symptoms improved when treated with oral vancomycin".As I understand it, Dr. is currently treating a larger number of patients with this antibiotic. Is anyone in this group enrolled in this study, and if so, are they willing to comment about it?Many tha nks,Best regards,Dave (father of (21); PSC 07/03; UC 08/03) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 12, 2006 Report Share Posted September 12, 2006 i can speak to this as my son is in dr. cox's vanco study at lpch in palo alto. travis was diagnosed with psc in feb. with severe portal hypertension and cirrhosis. we started him on the vanco in march and his enzymes have continued to fall. last month his numbers did not go down as much as hoped le so we are looking for better results the end of this month. he has been listed for tx with a current inactive status. most of the children with psc without cirrhosis have done well. the latest study will be published shortly. the vanco has been our only hope and so far it has kept travis out of transplant. my son was 6 months from total liver failure with no overt sx's. the portal hypertension was discovered incidently during a routine endoscoopy for his reflex disease. he does not have uc. he is 16 years old and has always been very healthy. it was a complete surprise. dr. cox and his team have been great! rita -------------- Original message -------------- Dear All;I'd like to initiate a discussion about this rather obscure paper:J Pediatr Gastroenterol Nutr. 1998 Nov;27(5):580-3. Oral vancomycin: treatment of primary sclerosing cholangitis in children with inflammatory bowel disease. KL, KMDepartment of Pediatrics, Lucile Salter Packard Children's Hospital at Stanford University, Palo Alto, California 94304, USA.PMID: 9822326You can access the full text at:www.jpgn.org/pt/re/jpgn/fulltext.00005176-199811000-00015.htmThe paper describes "three children with sclerosing cholangitis and inflammatory bowel disease whose liver tests and symptoms improved when treated with oral vancomycin".As I understand it, Dr. is currently treating a larger number of patients with this antibiotic. Is anyone in this group enrolled in this study, and if so, are they willing to comment about it?Many tha nks,Best regards,Dave (father of (21); PSC 07/03; UC 08/03) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2006 Report Share Posted September 13, 2006 Dear Rita; Thanks for responding about this trial. I hope that continues to show improvement on the vancomycin. I look forward to seeing the new study results! If they are as dramatic as the original study (1998) then this would seem to be a significant development in halting this disease. Best regards, Dave (father of (21); PSC 07/03; UC 08/03) > > i can speak to this as my son is in dr. cox's vanco study at lpch in palo alto. travis was diagnosed with psc in feb. with severe portal hypertension and cirrhosis. we started him on the vanco in march and his enzymes have continued to fall. last month his numbers did not go down as much as hoped le so we are looking for better results the end of this month. he has been listed for tx with a current inactive status. most of the children with psc without cirrhosis have done well. the latest study will be published shortly. the vanco has been our only hope and so far it has kept travis out of transplant. my son was 6 months from total liver failure with no overt sx's. the portal hypertension was discovered incidently during a routine endoscoopy for his reflex disease. he does not have uc. he is 16 years old and has always been very healthy. it was a complete surprise. dr. cox and his team have been great! > > rita > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2006 Report Share Posted September 13, 2006 ----Original Message----- I'd like to initiate a discussion about this rather obscure paper: Oral vancomycin: treatment of primary sclerosing cholangitis in children with inflammatory bowel disease. I found these 2 studies - Ann Pharmacother. 2006 Jun;40(6):1186-9. Epub 2006 May 23. Vancomycin-induced elevation of liver enzyme levels. Cadle RM, Mansouri MD, Darouiche RO. Pharmacy Service and Section of Infectious Diseases, E DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX 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. PMID: 16720708 [PubMed - indexed for MEDLINE] ------------------------------------------------------ Then there is this…… Clin Pharmacokinet. 1993 Jan;24(1):46-58. Clinical pharmacokinetics of newer antibacterial agents in liver disease. Westphal JF, Brogard JM. Department of Internal Medicine B, Hospitalo-University Center, Strasbourg, France. Liver disease may produce significant, albeit highly variable, effects on the pharmacokinetic behaviour of antibiotics in serum. Drug disposition may be altered through several pathophysiological mechanisms including reduced hepatobiliary clearance, and modifications in the volume of distribution induced by albumin synthesis deficiency or portal hypertension-related ascites. Antibacterial agents are not affected by potential alteration in hepatic first-pass effects. Only liver cirrhosis-induced effects on serum pharmacokinetics of antibiotics have been extensively studied, unlike those possibly produced by other forms of liver disease. In liver cirrhosis, pharmacokinetic alterations of nearly all beta-lactam or quinolone agents appear not to be marked enough to require dosage adjustment, provided that renal function stays normal. Adaptation in therapeutic schedule, however, is warranted for those drugs that are substantially cleared by the hepatobiliary system, namely mezlocillin, clindamycin, erythromycin, pefloxacin, enoxacin, antituberculous agents or nitroimidazole derivatives. Special caution should also be exercised when using aminoglycosides or vancomycin because of the wide interpatient variability of their pharmacokinetic disposition and their toxic potential. When renal function is impaired and there is an increased volume of distribution due to ascites, as frequently observed in severe liver insufficiency, the elimination half-life of most antibiotics is markedly prolonged, resulting in potential side effects due to drug accumulation. Accordingly, dosage adjustment applies to all drugs. In this regard, it should be remembered that delineating the dosage guidelines for a given antibiotic on the basis of reported pharmacokinetic parameters in patients with liver cirrhosis is awkward and probably of limited value. This pattern is ascribed to large interpatient variability in the active hepatic cell mass, the degree of portal hypertension and the alteration of serum binding capacity. Furthermore, there is no way of predicting accurately the extent of liver insufficiency in an individual patient. Dosage reduction is thus done empirically in most cases. Whenever possible, direct measurements of serum antibiotic concentrations should be the reasonable approach to manage antibiotic therapy in this kind of clinical condition. PMID: 8448972 [PubMed - indexed for MEDLINE] Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2006 Report Share Posted September 13, 2006 Are these studies only in children with PSC or has vancomycin been tested for adults as well? > > > > i can speak to this as my son is in dr. cox's vanco study at lpch > in palo alto. travis was diagnosed with psc in feb. with severe > portal hypertension and cirrhosis. we started him on the vanco in > march and his enzymes have continued to fall. last month his numbers > did not go down as much as hoped le so we are looking for better > results the end of this month. he has been listed for tx with a > current inactive status. most of the children with psc without > cirrhosis have done well. the latest study will be published > shortly. the vanco has been our only hope and so far it has kept > travis out of transplant. my son was 6 months from total liver > failure with no overt sx's. the portal hypertension was discovered > incidently during a routine endoscoopy for his reflex disease. he > does not have uc. he is 16 years old and has always been very > healthy. it was a complete surprise. dr. cox and his team have been > great! > > > > rita > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2006 Report Share Posted September 13, 2006 the study focuses on children but i do believe they are diong it for adults too through stanford. rita -------------- Original message -------------- Are these studies only in children with PSC or has vancomycin been tested for adults as well? > >> > i can speak to this as my son is in dr. cox's vanco study at lpch > in palo a lto. travis was diagnosed with psc in feb. with severe > portal hypertension and cirrhosis. we started him on the vanco in > march and his enzymes have continued to fall. last month his numbers > did not go down as much as hoped le so we are looking for better > results the end of this month. he has been listed for tx with a > current inactive status. most of the children with psc without > cirrhosis have done well. the latest study will be published > shortly. the vanco has been our only hope and so far it has kept > travis out of transplant. my son was 6 months from total liver > failure with no overt sx's. the portal hypertension was discovered > incidently during a routine endoscoopy for his reflex disease. he > does not have uc. he is 16 years old and has always been very > healthy. it was a complete surprise. dr. cox and his team have been > great!> > > > rit a> > > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2006 Report Share Posted September 13, 2006 the study focuses on children but i do believe they are diong it for adults too through stanford. rita -------------- Original message -------------- Are these studies only in children with PSC or has vancomycin been tested for adults as well? > >> > i can speak to this as my son is in dr. cox's vanco study at lpch > in palo a lto. travis was diagnosed with psc in feb. with severe > portal hypertension and cirrhosis. we started him on the vanco in > march and his enzymes have continued to fall. last month his numbers > did not go down as much as hoped le so we are looking for better > results the end of this month. he has been listed for tx with a > current inactive status. most of the children with psc without > cirrhosis have done well. the latest study will be published > shortly. the vanco has been our only hope and so far it has kept > travis out of transplant. my son was 6 months from total liver > failure with no overt sx's. the portal hypertension was discovered > incidently during a routine endoscoopy for his reflex disease. he > does not have uc. he is 16 years old and has always been very > healthy. it was a complete surprise. dr. cox and his team have been > great!> > > > rit a> > > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2006 Report Share Posted September 13, 2006 > > Dear All; > > I'd like to initiate a discussion about this rather obscure paper: > I've read the other posts on this and I'd like to add that vancomycin is an aminoglycoside (like my dreaded gentamicin) and can cause vestibular damage, as well as renal damage, in SOME individuals. For those who don't know my story: " gent " has caused permanent damage to the hair cells in my inner ears and it has resulted in a permanent loss of balance. While I have no other daily reminders of my illness (other than a colorful and necessary collection of pills), my cane and loss of balance plague me daily. Perhaps the oral vanco is less damaging to patients???? Penny Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2006 Report Share Posted September 13, 2006 the vanco is not absorbed in the blood but only goes to the gut. it has few side effects. rita -------------- Original message -------------- >> Dear All;> > I'd like to initiate a discussion about this rather obscure paper:> I've read the other posts on this and I'd like to add that vancomycinis an aminoglycoside (like my dreaded gentamicin) and can causevestibular damage, as well as renal damage, in SOME individuals. Forthose who don't know my story: "gent" has caused permanent damage tothe hair cells in my inner ears and it has resulted in a permanentloss of balance. While I have no other daily reminders of my illness(other than a colorful and necessary collection of pills), my cane andloss of balance plague me daily. Perhaps the oral vanco is lessdamaging to patients????Penny Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2006 Report Share Posted September 13, 2006 the vanco is not absorbed in the blood but only goes to the gut. it has few side effects. rita -------------- Original message -------------- >> Dear All;> > I'd like to initiate a discussion about this rather obscure paper:> I've read the other posts on this and I'd like to add that vancomycinis an aminoglycoside (like my dreaded gentamicin) and can causevestibular damage, as well as renal damage, in SOME individuals. Forthose who don't know my story: "gent" has caused permanent damage tothe hair cells in my inner ears and it has resulted in a permanentloss of balance. While I have no other daily reminders of my illness(other than a colorful and necessary collection of pills), my cane andloss of balance plague me daily. Perhaps the oral vanco is lessdamaging to patients????Penny Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2006 Report Share Posted September 13, 2006 --Original Message-- the vanco is not absorbed in the blood but only goes to the gut. http://www.labcorp.com/datasets/labcorp/html/chapter/mono/td024700.htm States: Vancomycin is poorly absorbed from the gastrointestinal tract. Vancomycin is eliminated by the kidneys, primarily by glomerular filtration; 80% to 90% of a dose appears in the urine of healthy subjects as unchanged drug within 24 hours. The usual elimination half-life in adults with normal renal function ranges from three to nine hours (mean, six hours). In one study, longer elimination half-lives were reported for men older than 60 years compared to men between 20 and 26 years (mean half-lives, 12.1 and 7.2 hours, respectively). Elimination half-lives are 5.9-9.8 hours in newborns, 4.1 hours in older infants, and 2.2-4 hours in children. In anuric patients, the half-life may be prolonged to eight or nine days. Dosage reductions are necessary in patients with renal insufficiency. Although it has been reported that elimination is prolonged in patients with impaired hepatic function, the consensus is that nonrenal elimination is minor and dosage reductions are unnecessary. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2006 Report Share Posted September 13, 2006 --Original Message-- the vanco is not absorbed in the blood but only goes to the gut. http://www.labcorp.com/datasets/labcorp/html/chapter/mono/td024700.htm States: Vancomycin is poorly absorbed from the gastrointestinal tract. Vancomycin is eliminated by the kidneys, primarily by glomerular filtration; 80% to 90% of a dose appears in the urine of healthy subjects as unchanged drug within 24 hours. The usual elimination half-life in adults with normal renal function ranges from three to nine hours (mean, six hours). In one study, longer elimination half-lives were reported for men older than 60 years compared to men between 20 and 26 years (mean half-lives, 12.1 and 7.2 hours, respectively). Elimination half-lives are 5.9-9.8 hours in newborns, 4.1 hours in older infants, and 2.2-4 hours in children. In anuric patients, the half-life may be prolonged to eight or nine days. Dosage reductions are necessary in patients with renal insufficiency. Although it has been reported that elimination is prolonged in patients with impaired hepatic function, the consensus is that nonrenal elimination is minor and dosage reductions are unnecessary. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2006 Report Share Posted September 13, 2006 --Original Message-- the vanco is not absorbed in the blood but only goes to the gut. http://www.labcorp.com/datasets/labcorp/html/chapter/mono/td024700.htm States: Vancomycin is poorly absorbed from the gastrointestinal tract. Vancomycin is eliminated by the kidneys, primarily by glomerular filtration; 80% to 90% of a dose appears in the urine of healthy subjects as unchanged drug within 24 hours. The usual elimination half-life in adults with normal renal function ranges from three to nine hours (mean, six hours). In one study, longer elimination half-lives were reported for men older than 60 years compared to men between 20 and 26 years (mean half-lives, 12.1 and 7.2 hours, respectively). Elimination half-lives are 5.9-9.8 hours in newborns, 4.1 hours in older infants, and 2.2-4 hours in children. In anuric patients, the half-life may be prolonged to eight or nine days. Dosage reductions are necessary in patients with renal insufficiency. Although it has been reported that elimination is prolonged in patients with impaired hepatic function, the consensus is that nonrenal elimination is minor and dosage reductions are unnecessary. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2006 Report Share Posted September 13, 2006 Thanks for the heads up. Although I am always seriously concerned about that class of drugs, I also believe that some drugs and procedures work better (and more safely) for some people than others. is a perfect example of: "if it ain't broke, don't fix it." Penny Re: Re: Vancomycin and primary sclerosing cholangitis the vanco is not absorbed in the blood but only goes to the gut. it has few side effects. rita Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2006 Report Share Posted September 13, 2006 Thanks for the heads up. Although I am always seriously concerned about that class of drugs, I also believe that some drugs and procedures work better (and more safely) for some people than others. is a perfect example of: "if it ain't broke, don't fix it." Penny Re: Re: Vancomycin and primary sclerosing cholangitis the vanco is not absorbed in the blood but only goes to the gut. it has few side effects. rita Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2006 Report Share Posted September 13, 2006 Thanks for the heads up. Although I am always seriously concerned about that class of drugs, I also believe that some drugs and procedures work better (and more safely) for some people than others. is a perfect example of: "if it ain't broke, don't fix it." Penny Re: Re: Vancomycin and primary sclerosing cholangitis the vanco is not absorbed in the blood but only goes to the gut. it has few side effects. rita Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 13, 2006 Report Share Posted September 13, 2006 wrote: > Posted by: " " rhodesdavid@... rhodesdavidwl > Tue Sep 12, 2006 9:43 pm (PST) > > Dear All; > > I'd like to initiate a discussion about this rather obscure paper: > > J Pediatr Gastroenterol Nutr. 1998 Nov;27(5):580-3. > > Oral vancomycin: treatment of primary sclerosing cholangitis in > children with inflammatory bowel disease. > > KL, KM > > Department of Pediatrics, Lucile Salter Packard Children's Hospital > at Stanford University, Palo Alto, California 94304, USA My son, who has PSC, participated in this study. His condition neither improved or worsened as a result of the medication. According to some of the doctors we spoke with, the drug has shown real promise with some patients. They are not certain why. Harold Stuart San , California Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 26, 2006 Report Share Posted September 26, 2006 I acttually participatied in the Vanco study as an adult in the late 90s. In my case no change was noted, and I took it for a good year. I had no side effects from the Vanco. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 26, 2006 Report Share Posted September 26, 2006 I acttually participatied in the Vanco study as an adult in the late 90s. In my case no change was noted, and I took it for a good year. I had no side effects from the Vanco. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted September 27, 2006 Report Share Posted September 27, 2006 > > Thanks for responding to this. Do you have an idea of how the other > adults in the study responded? I have no idea about anyone else in the study. It was very informal. They asked me to try taking Vanco to see if it worked. It didn't really help. >Also, have you had bacterial > cholangitis attacks or a transplant since? I had a hell of a time with infections prior to my tx in June 2004. At the time of transplant, I had an MRSA infection. Quote Link to comment Share on other sites More sharing options...
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