Vancomycin-induced elevation of liver enzyme levels

Area of Science:

• Hepatology
• Pharmacology
• Gastroenterology

Background:

• Clostridium difficile-associated enterocolitis requires effective antibiotic treatment.
• Oral vancomycin is an alternative for metronidazole-refractory cases.
• Oral vancomycin typically has poor bioavailability and is not associated with liver toxicity.

Observation:

• A patient with recurrent C. difficile enterocolitis experienced significant alanine aminotransferase and aspartate aminotransferase elevations during five separate courses of oral vancomycin.
• These liver enzyme elevations normalized after each course of oral vancomycin was stopped.
• The Naranjo probability scale suggested a probable association between oral vancomycin and the observed hepatic enzyme elevation.

Findings:

• This is the first reported case of oral vancomycin causing elevated liver enzyme levels.
• The patient's underlying inflammatory bowel disease may have contributed to increased oral vancomycin absorption.
• The hepatic enzyme elevations were reversible upon cessation of the antibiotic.

Implications:

• Clinicians should be aware of the potential for oral vancomycin to cause hepatotoxicity, despite its generally accepted safety profile.
• Monitoring of liver function may be warranted in patients receiving prolonged or repeated courses of oral vancomycin, particularly those with inflammatory bowel disease.
• This case expands the known adverse effect profile of oral vancomycin.