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207 VANCOMYCIN AS AN EFFECTIVE TREATMENT IN SEVERE REFRACTORY ULCERATIVE COLITIS F Aba-Alkhail, J Howard BACKGROUND: One theory of the etiology of ulcerative colitis (UC) is that UC is the consequence of genetic susceptibility combined with an abnormal immune response to commensal bacteria. One previous double-blind trial has shown effectiveness of vancomycin in avoiding colectomy in patients with severe UC who have failed high dose steroid and 5-ASA therapy. We report the use of vancomycin in six adolescent patients with severe UC. All six patients were males aged 14 to 18. Five had UC refractory to high dose prednisone and 5-ASA. One had a severe exacerbation of UC who did not wish treatment with prednisone. The decision to use vancomycin was made on a case by case basis as a 'last ditch effort' to prevent colectomy. All had UC confirmed by colonoscopy and colonic biopsy within one year of treatment with vancomycin. All patients had failed standard medical therapy (high dose steroids, 5-ASA compounds, azathioprine) and were being referred for colectomy. Oral vancomycin was given in a dose of 500-1000 mg per day in 250 mg dose for a prolonged time with an average of 9 months duration. All six patients showed significant improvement clinically with disappearance of blood, diarrhea and cramping within 3 to 4 days which allowed complete tapering of steroids within 6 weeks. There have been no subsequent flares with up to 18 months of follow-up. Unfortunately only two patients were tested for Clostridium difficile toxin and were negative prior to starting vancomycin. The others were not tested but none were clinically suspected as having C. difficile colitis. Two patients are now on azathioprine, vancomycin and 5-ASA while two are on vancomycin and 5-ASA, one is on azathioprine and vancomycin and the last patient is on vancomycin alone.
Paediatric Gastroenterology, London Health Sciences Centre, University of Western Ontario, London, Ontario
CONCLUSIONS: This preliminary data suggests that oral vancomycin may be effective therapy in severe refractory UC and may reduce the need for operative intervention in these patients. This preliminary data supports the need for a double-blind controlled study of oral vancomycin (500-1000 mg/day) in C.difficile-negative patients with severe UC.