Oral Vancomycin as a Therapeutic Option for PSC

Slides:

Advertisements

Similar presentations

Implementing NICE guidance

Advertisements

Managing Crohn’s Disease through Nutritional Intervention

David J. Hass, MD Assistant Clinical Professor of Medicine Yale University School of Medicine Gastroenterology Center of Connecticut, P.C.

Relapsing and Severe C. difficile Disease Role of Fecal Microbiota Transfer.

FMT for Children with Recurrent Clostridium difficile Infection George Hylands Russell, MD, MSc 2014 James W. Freston Conference Chicago, Illinois August.

Immunomodulators and Biologics Maria T. Abreu, MD University of Miami Miller School of Medicine Miami, Florida.

HIGH VALUE CARE GI CONDITIONS CHRONIC DIARRHEA EDWARD LEVINE MD OSUWMC OCTOBER 11, 2014.

Colitis in the Very Young

Clostridium Difficile (C.diff): Fast Facts. What is Clostridium difficile (C. diff)? C. diff is a bacteria that lives in the intestinal tract of about.

Thiopurines still have a role in the management of pediatric IBD Athos Bousvaros MD, MPH Associate Director, IBD program Boston Children’s Hospital.

C. Difficile and Fecal Microbiota Therapy

Ulcerative Colitis.

The Patient With Pyoderma Gangrenosum Maria T. Abreu, MD Chief, Division of Gastroenterology University of Miami Miller School of Medicine Miami, Florida.

Antimicrobial Resistance in N. gonorrhoeae: In Brief 2014 INTRODUCTION Increased action is needed to help prevent and control gonorrhea. Worldwide antimicrobial.

When can we use combination therapy for our pediatric IBD patients? Athos Bousvaros MD, MPH Advances in IBD Dec 2014.

Progress in Diagnosing and Treating Clostridium difficile in IBD patients Alan C. Moss MD, FEBG, FACG, AGAF Associate Professor of Medicine Director of.

Antimicrobials and risks for antibiotic-associated diarrhea (AAD) Antibiotic-associated diarrhea 5-30% risk Higher with multiple IV drugs Higher with broad.

Inflammatory Bowel Disease Ulcerative colitis (UC) Kristina Blaslov Mentor: A. Žmegač Horvat.

Asymptomatic UC patients on an immunomodulator with persistent moderate mucosal inflammation should either add a biologic or switch to a biologic William.

Inflammatory Bowel Disease

Pediatric IBD Research

Clostridium difficile Infection (CDI): Increasingly Severe and Rapidly Fatal Disease Requires High Certainty of Treatment Efficacy Dale N. Gerding, MD.

Antibiotic overuse and misuse in long term care Shira Doron, MD Assistant Professor of Medicine Division of Geographic Medicine and Infectious Diseases.

Clostridium difficile Prevention and Treatment Katrina Beining & Christina Gardner Introduction Clostridium difficile (C. diff) is a gram-positive, spore-forming.

DAREDEVILS: Prajwal Acharya, Cristina Johnson, Julie David, Jen Masciovecchio, Yen Phan.

Colonoscopic surveillance for prevention of colorectal cancer in people with ulcerative colitis, Crohn’s disease or adenomas NICE CG March 2011.

CROHN’S DISEASE Alison Cunliffe. What is Crohn’s Disease?  Chronic inflammatory disease of the intestines  Causes ulcerations, breaks in the lining,

Shira Doron, MD Assistant Professor of Medicine

Primary Sclerosing Cholangitis

What is the Deal About FMT? Herbert L. DuPont, MD Director, Center for Infectious Diseases, University of Texas School of Public Health President, Kelsey.

Advances in PSC Research and Future Directions

Clinical Experience With Antibiotic Protocol & RSD N=22 Duration of treatment: 2-4 months Retrospective, open label, clinical trial Responses are based.

Nilofar Rahman, MD RISK OF RECURRENCE OF CLOSTRIDIUM DIFFICILE INFECTION WITH PPI USE.

The only end-points of therapy that matter are mucosal healing, normal blood work, and negative radiologic studies. Robert N. Baldassano, MD Colman Family.

CLINICAL AND ENDOSCOPIC CORRELATION OF INFLAMMATORY BOWEL DISEASE Coordinator: Prof. Univ. Dr. Simona Băţagă Students: Andra Oltean Stoica Ioan Adrian.

Crohn’s Disease & Mycobacterial Infections Kimberly Persley, MD October 19, 2005.

Inflammatory Bowel Disease Crohn’s Disease And Ulcerative Colitis.

(A) Surveillance colonoscopies for detecting dysplasia and preventing colorectal carcinoma. (B) Management of visible lesions at endoscopy. A visible lesion.

Ulcerative Colitis Rachel Gavin.

R1 김동연 /prof. 이창균. Introduction  Recurrent Clostridium difficile infection is difficult to treat, and failure rates for antibiotic therapy are high.

Clostridium difficile infections

Hot Topics in Antibiotic Management of Pediatric CF Lung Disease Mike Tracy, MD Fellow, Pediatric Pulmonary.

Don’t Let Your Sinus Infection Turn Into a Life Threatening Colon Infection.

© 2013 Pearson Education, Inc. Bell Ringer  What is an endospore, and what special characteristics do endospore forming bacteria have?

Complications in IBD for acute internal medicine S Sebastian.

GASTROENTEROLOGY 2008; 134 :688–695 소화기내과 R4 이 재 연.

Page  2 Accutane, a medication used to treat acne, has recently been linked to dangerous health conditions such as inflammatory bowel disease (IBD).

PREVALENCE OF OSTEOMYELITIS IN HIV INFECTED PATIENTS. PRESENTERS: 1. MOHAMED M. NOORANY- MBChB V (MUSOM) 2. MUKOYA AQUINATA (Sr)- MBChB V (MUSOM) FACILITATORS:

Introduction to PSC: From A to Z

Seema Jain and Kristen Lewis MD

Oral Vancomycin Effect in Primary Sclerosing Cholangitis

Dr Gill Watermeyer IBD Clinic Division of Gastroenterology

Clostridium difficile Infection Biology & Public Health Impact

Seeking Treatments for PSC Out of the Desert and into the Woods

Use of antibiotics.

Antimicrobial Therapy (Vancomycin and/or Metronidazole)

Chronic Hepatitis C Virus Infection

Primary Sclerosing Cholangitis in Children

Basics of PSC Christopher L. Bowlus, MD

Clinical Considerations in Evidence-based Management of GIST

Management of Clostridium Difficile Infection

Steven H Itzkowitz, Noam Harpaz Gastroenterology

Microscopic Colitis Gastroenterology

Clinical Considerations in Evidence-based Management of GIST

Infliximab trough levels above 7 μg/mL in inflammatory bowel disease treated with infliximab: Better control of inflammation without increased risk of.

Cox regression analysis of the proportion of patients remaining in remission during azathioprine treatment related to diagnosis of inflammatory bowel disease.

Cox regression analysis of the proportion of patients remaining in remission after stopping azathioprine treatment related to diagnosis of inflammatory.

Pediatric PSC Experience

Peritonitis treatment algorithm.

Presentation transcript:

Oral Vancomycin as a Therapeutic Option for PSC Yinka Davies, MD Adjunct Clinical Assistant Professor, Stanford School of Medicine PSC Partners Seeking a Cure 2018 Annual Conference June 23, 2018

About oral vancomycin Glycopeptide antibiotic for Gram-positive bacteria, targeting the colon Commonly used to treat Clostridium difficile (C. diff)-associated diarrhea Not absorbed by the gut

Case study 15 year old boy with PSC, IBD and C. diff infection Liver tests decreased and PSC symptoms subsided After course of vancomycin, elevated labs and symptoms returned A second course of treatment provided same improvements

Case study – cont. Repeated in multiple PSC patients without C.diff infection and has been treating PSC this way since (79+ patients treated, 75 responded between Dr. Cox & Dr. Davies)

Treatment regimen 50 mg/kg/day, typically 500mg 3 times/day Long-term therapy Brand or brand generic (ANI) Early stage disease (Stages 0-2)

Liver function tests

Liver function tests # times above max # times above max

Symptoms Itching, fatigue, diarrhea, weight loss typically subside within first month or two of treatment No common related adverse events reported VRE uncommon (0.03%-0.68%)1 - not absorbed by the gut

Pathology Improvement or at least no progression on annual: Liver biopsy Colonoscopy (Inflammatory Bowel Disease) Reduced inflammation in non- cirrhotic patients

Pathology - PSC Liver biopsy results (13 patients) 9 showed decrease in disease 3 showed no histologically evident increase or decrease in pathology 1 showed stigmata of increased pathology/disease progression

Pathology - IBD Endoscopy results (11 patients) 7 changed from chronic active colitis to unremarkable colonic mucosa or chronic inactive colitis 4 had no change: 2 consistent chronic active colitis in before & after 2 no pathologic abnormalities in before & after

Next steps A standardized treatment protocol Dosing Duration of treatment Monitoring for response to therapy Adult vs. pediatric Other therapies C. diff now being treated with FMT

References 1. Remschmidt C, Behnke M, Kola A, et al. The effect of antibiotic use on prevalence of nosocomial vancomycin-resistant enterococci - an ecologic study. Antimicrob Resist Infect Control. 2017;6:95. 2. Davies YK, Cox KM, Abdullah BA, Safta A, Terry AB, Cox KL: Long-term treatment of primary sclerosis cholangitis in children with oral vancomycin: an immunomodulating antibiotic. Journal of Pediatric Gastroenterology and Nutrition, 47(1): 61-7, July 2008.