Absorption of oral vancomycin - possible associated toxicity.

We report a case of an anephric child who accumulated significant concentrations of vancomycin during oral therapy for Clostridium difficile pseudomembranous colitis. Sustained serum vancomycin levels of 34 microgram/ml and CSF level of 4.2 microgram/ml were documented during an unexplained clinical syndrome of fever and encephalopathy. Discontinuation of drug and performance of hemodialysis reduced serum concentrations to 24 microgram/ml and were associated with rapid resolution of symptoms. Patients with renal impairment and intestinal disease who receive oral vancomycin may absorb and accumulate significant amounts of drug.