We had a consultation with a liver specialist yesterday who indicated that one potential risk of vanco is that if you need to have a liver transplant, the long-term use of vanco may make it difficult to do a transplant as there could be a risk that your body (or liver?) does not respond to antibiotics that would be needed to accomplish the transplant. I had not heard of this and it does not dissuade us from moving forward with vanco for our young son. But, any thoughts?
Never heard this.
Well, that’s his opinion. There isn’t any actual research on very long term vanco use, so we can’t really claim anything. Keep in mind though that this is a drug that has been used since the 1950’s.
I’m not a doctor, but in my opinion there’s a bunch of errors in that statment. For example, just because you take vancomycin doesn’t make you more likely to get a vancomycin-resistant bacteria infection (it’s very unlikely to get it in the first place). Also, if you actually got such an infection, it doesn’t mean that it couldn’t be treated by another antibiotic.
The way you have explained it is a little different but, if I’ve interpreted what your doctor was meaning correctly, there are many doctors who agree.
Vanco is a hospital grade antibiotic generally used to treat resistant bacterial infections. The theory goes that if you use Vanco (or any antibiotic) regularly, you may develop antibiotic resistance. Then when a normally treatable bacterial infection occurs, antibiotics don’t work. I was told “what’s the good of maybe saving his liver, but dying from pneumonia (as an example) that can’t be treated due to antibiotic resistance”.
It has relevance to transplants as the anti rejection drugs taken post-transplant also lower general immunity, making you more prone to catching infections.
In spite of all of that, my child is on Vanco
I think a good thing to point out is that using antibiotics makes society as a whole more likely to spread resistant bacteria. It doesn’t simply increase your risk, it increases everyones risk slightly. The person taking vanco isn’t more likely to get such an infection compared to anyone else, but everyone’s risk is higher if a lot of people take vanco. Also, antibiotics doesn’t change the bacteria, it just promotes the resistant strains to replicate (this is an example of natural selection).
Long-term use of oral vancomycin is novel and we don’t have any hard data. There could be some as yet unknown risk. Notably, anecdotal long-term use has not yet revealed any side effects of note or revealed any previously unknown resistance issues.
It’s easier to comment on known resistance issues associated with vancomycin.
Our gut has a variety of different bacteria that are in competition with each other for resources. Oral antibiotics kill susceptible bacteria and leave behind bacteria that are resistant to the type and concentration of antibiotic taken. These remaining bacteria, in the absence of their usual competition, change in composition and increase in numbers. About 6 weeks after stopping antibiotic treatment the gut returns mostly to its previous pre-antibiotic state of equilibrium.
The big resistance issues involving vancomycin revolve around Vancomycin Resistant Enterococci (VRE). While an overgrowth in a healthy person is unlikely to cause symptoms, for a compromised individual these bacteria can cause problems and even be fatal. Another issue is that MRSA can learn vancomycin resistance from VRE. The resulting VRSA is a superbug resistant to everything.
Despite all of the serious resistance issues associated with the overuse of vancomycin, I’d make the argument that its use for the treatment for PSC actually decreases the incidence of these issues by helping to keep people healthy and out of the hospital. VRE and MRSA are almost exclusively spread and acquired in a hospital ICU setting. One does not need prior or concurrent vancomycin exposure to acquire a VRE overgrowth, the major individual risk factors are a compromised immune system and location.
Another point is that for many of us long-term antibiotic use is an inevitability whether this is to stave off bacterial cholangitis or to treat symptoms such as itching. Whether we are thinking about side effects, resistance issues, or quality of life, I’d argue that a proactive course of an antibiotic with no detectable systemic absorption beats the alternative.
Good comments here. The way I look at it is that vanco is the only drug I have seen that has worked to keep PSC at bay, particularly in kids. Otherwise, you are looking at an almost certain liver transplant, which itself fails 40% of the time. We have 3 physicians seeing my son. The liver specialist who has used it for 8 years (following Dr. Cox’s protocol) has said he has seen it work especially in young kids and that if it were his son, this is what he would do. The other liver specialist we are working with is not opposed to it, but brought up the risk. She says she would not use it for young children, but would consider it for adolescents and adults. The other liver specialist who prescribes it says the opposite–that he has seen it work better in young kids.
Well explained jtb. Thanks for your detailed answer. All the best. Daniela
Our daughter’s Pediatric-gi told us that, from what he’s read, vanco is processed in the gut, and there’s no risk for it to affect antibiotic resistance as you mentioned. My daughter was diagnosed with PSC at age 7. We started vancomycin a year later, and it’s frozen its progression . She’s now 14.