Please don’t use IV Vancomycin for treating C.Diff !! 😐

I should not have to write a post on this, but in the last 10 years I have encountered Intravenous (IV) Vancomycin attempted for treating C.Diff colitis at least 3 times. While a buddy of mine also came across a Vancomycin error in reverse – patient was prescribed oral Vancomycin for treating cellulitis !! Noooooo ! That would be medical malpractice if it causes a bad outcome 😑.

Vancomycin has poor to no intestinal luminal penetration when given IV and poor to no systemic intestinal absorption when given orally. That is not to say that some of it does not happen – IV Vancomycin can be excreted via bile in the interstinal lumen, while oral vancomycin could have some systemic absorption. These effects are inconsistent across all people & highly variable even in the same person, thus not reliable in use for treatment purposes.

However, as a clinician, you still need to be aware that such ‘crossover’ or ‘leak’ can occur from blood to intestinal lumen and vice-versa since this can cause occasional side-effects ! Long term IV Vancomycin use can rarely cause C.Diff itself and is implicated in VRE colonzation , while Oral Vancomycin can occasionally cause Red-man syndrome, ototoxicy and renal failure. The logic here being with colitis, the intestinal surface is more permeable for the drug entering the blood-stream. This risk is enhanced with more severe / fulminant colitis, renal failure (or hemodialysis patients) and prolonged course of treatement.

💡 Teaching Point: Choose route of Vancomycin administration correctly – Oral only for C.Diff and IV only for everything else) – but be aware that occasional cross-over from blood to intestine and vice-versa can be significant enough for side-effects , with risks for these as discussed above.

So next time you see IV Vancomycin being used for C.Diff colitis, take a piece of newspaper 📰, roll it up 🗞 real good & swat that bug 🕷 of medical error as fast as you can !