MULTIPLE-DOSE ACTIVATED-CHARCOAL IN AN ACCIDENTAL VANCOMYCIN OVERDOSE

Background: Multiple-dose activated charcoal may enhance the enterocap illary clearance of vancomycin. Case Report: A 17-day-old female neona te born with congenital meningomyelocele and Arnold-Chiari malformatio n was iatrogenically overdosed with a 500 mg intravenous bolus of vanc omycin during a shunt operation. The Red Man's Syndrome developed with in minutes, characterized by sudden hypotension, skin rash and cyanosi s. Serum vancomycin level at one hour after the injection was 165.7 mu g/mL, as measured by an enzyme immunoassay method (EMIT (R)). Multipl e dose activated charcoal, 1 g/kg, was first given five hours after in jection, and continued every four hours for 12 doses. The half-life of vancomycin during charcoal administration was calculated to be 9.4 h or less than the reported 13.4-33.7 h half-life in normal neonates. Th e neonate's renal function tests and brainstem auditory responses rema ined normal. Conclusions: Gastrointestinal dialysis with multiple-dose activated charcoal without cathartics appeared to shorten the elimina tion half-life of vancomycin.