We recently published our experience with oral vancomycin as an effective treatment of primary sclerosing cholangitis in children (Journal of Pediatric Gastroenterology and Nutrition 47(1):61-67, 2008). On oral vancomycin, liver enzyme levels and other diagnostic studies to evaluate liver disease normalized in 10 children who did not have cirrhosis and improved in the 4 children with cirrhosis. When the vancomycin was stopped after 2 to 3 months of therapy, abnormalities of blood liver enzymes and sedimentation rate recurred. When children were retreated and maintained on long term therapy, the liver enzymes remained normal.
Oral vancomycin is poorly absorbed from the gastrointestinal tract. It can act as an antibiotic and has immune modulator effects. Vancomycin, a bactericidal antibiotic, is effective against Gram-positive bacteria. Vancomycin has been shown to effect the release of substance from immunologic cells which promote inflammation. To determine the possible mechanisms in which oral vancomycin is treating primary sclerosing cholangitis we have clinical research studies to identify changes in the bacteria in the gastrointestinal tract and blood cytokine levels before and while on oral vancomycin.