Enhanced oral bioavailability of vancomycin in rats treated with long-term parenteral nutrition

Long-term parenteral nutrition (PN) can induce intestinal atrophy, leading to a loss of epithelial integrity in the small intestines. This change may alter the intestinal permeability of vancomycin (VCM), a non-absorbable antibiotic. The aim of the present study was to investigate the effect of PN on the pharmacokinetics of VCM in rats. VCM was intravenously (5 mg/kg) or intraduodenally (20 mg/kg) administered to control and PN rats, which were prepared by administration of PN for 9 days. After intravenous administration, there were no significant differences in any of the VCM pharmacokinetic parameters between the control and PN rats. However, after intraduodenal administration, the maximum concentration and area under the plasma concentration–time curve of VCM in PN rats was approximately 2.4- and 2.6-fold higher, respectively, than in the control rats; the calculated bioavailability was approximately 0.5 and 1.3 % in control and PN rats, respectively. These results indicated that PN administration did not affect VCM disposition, but enhanced VCM absorption; however, the enhanced oral VCM bioavailability was statistically, not clinically, significant. Therefore, while long-term PN administration may play a role in the enhancement of VCM bioavailability, this effect may be negligible without any complications.

[1]  M. Alpert,et al.  Significant Absorption of Oral Vancomycin in a Patient with Clostridium difficile Colitis and Normal Renal Function , 2006, Southern medical journal.

[2]  D. Deleu,et al.  Red man syndrome , 2002, Critical care.

[3]  M. Alison,et al.  Lower Insulin Secretory Response to Glucose Induced by Artificial Nutrition in Children: Prolonged and Total Parenteral Nutrition , 2007, Pediatric Research.

[4]  H. Endeman,et al.  Presence of tobramycin in blood and urine during selective decontamination of the digestive tract in critically ill patients, a prospective cohort study , 2011, Critical care.

[5]  N. Matsuda,et al.  Mechanisms of Inflammatory Response and Organ Dysfunction: Organ-Protective Strategy by Anesthetics. , 2014 .

[6]  H. O. Oudemans-van Straaten,et al.  Randomized clinical trial of perioperative selective decontamination of the digestive tract versus placebo in elective gastrointestinal surgery , 2011, The British journal of surgery.

[7]  N. Shibata,et al.  Highly sensitive quantification of vancomycin in plasma samples using liquid chromatography-tandem mass spectrometry and oral bioavailability in rats. , 2003, Journal of chromatography. B, Analytical technologies in the biomedical and life sciences.

[8]  F. Boucher,et al.  Possible Red-Man Syndrome Associated with Systemic Absorption of Oral Vancomycin in a Child with Normal Renal Function , 1994, The Annals of pharmacotherapy.

[9]  Asako Nishimura,et al.  Effect of intestinal atrophy and hepatic impairment induced by parenteral nutrition on drug absorption and disposition in rats. , 2015, JPEN. Journal of parenteral and enteral nutrition.

[10]  M. Puder,et al.  Treatment of parenteral nutrition-associated liver disease: the role of lipid emulsions. , 2013, Advances in nutrition.

[11]  I. Blasig,et al.  Sodium caprate transiently opens claudin-5-containing barriers at tight junctions of epithelial and endothelial cells. , 2012, Molecular pharmaceutics.

[12]  Yongjia Feng,et al.  Loss of enteral nutrition in a mouse model results in intestinal epithelial barrier dysfunction , 2012, Annals of the New York Academy of Sciences.

[13]  Yongjia Feng,et al.  Decline in intestinal mucosal IL-10 expression and decreased intestinal barrier function in a mouse model of total parenteral nutrition. , 2008, American journal of physiology. Gastrointestinal and liver physiology.

[14]  Kanji Takada,et al.  Enhanced intestinal absorption of vancomycin with Labrasol and D-alpha-tocopheryl PEG 1000 succinate in rats. , 2003, International journal of pharmaceutics.

[15]  Yongjia Feng,et al.  Enteral versus Parenteral Nutrition: Effect on Intestinal Barrier Function , 2009 .

[16]  Xiaoyi Sun,et al.  Impact of caloric intake on parenteral nutrition-associated intestinal morphology and mucosal barrier function. , 2006, JPEN. Journal of parenteral and enteral nutrition.

[17]  I. Alia,et al.  Enteral Vancomycin Controls Methicillin-resistant Staphylococcus Aureus Endemicity in an Intensive Care Burn Unit: A 9-Year Prospective Study , 2007, Annals of surgery.

[18]  T Iga,et al.  Effect of cilastatin on renal handling of vancomycin in rats. , 1998, Journal of pharmaceutical sciences.

[19]  W. Qin,et al.  Glycyl-glutamine-enriched long-term total parenteral nutrition attenuates bacterial translocation following small bowel transplantation in the pig. , 1999, The Journal of surgical research.

[20]  C. Hvas,et al.  Quality and safety impact on the provision of parenteral nutrition through introduction of a nutrition support team , 2014, European Journal of Clinical Nutrition.

[21]  H. Harmsen,et al.  Impact of digestive and oropharyngeal decontamination on the intestinal microbiota in ICU patients , 2010, Intensive Care Medicine.

[22]  N. Matsuda,et al.  Alert cell strategy: mechanisms of inflammatory response and organ protection. , 2014, Current pharmaceutical design.

[23]  R. Polk,et al.  Vancomycin-induced histamine release and "red man syndrome": comparison of 1- and 2-hour infusions , 1990, Antimicrobial Agents and Chemotherapy.

[24]  H. Khalili,et al.  Vancomycin-induced nephrotoxicity: mechanism, incidence, risk factors and special populations. A literature review , 2012, European Journal of Clinical Pharmacology.