Summary:
Autism remains one of the enigmas of diagnosis and management. Theories of
causation, pathology and remedies are thicker than flies. But, still we keep
searching for the answer. This one concerns use of a very potent antibiotic to
alter gut bacterial populations to decrease productions of some alleged
neurotoxins that cause or aggravate autistic behavior, though for a short time
only. Last revised January 21, 2007
VANCOMYCIN: CONTROVERSIAL
USE IN AUTISM
VANCOMYCIN
Vancomycin is a distinct class of antiobiotics unrelated to the family of
penicillins, streptomycin, cephalosporins, quinolones, sulfonamides,
erythromycin, etc. that we use routinely in medical practice. Its use in
medicine is reserved for the treatment of multi-drug resistant Staphylococcal
infections that are life threatening. It is a toxic drug
and its usage is best left to medical specialists.
AUTISM
What is autism and what causes it? We wish
we knew more.
There are many useful bacteria in our gut that, by competition for food, inhibit
the growth of many harmful bacteria in our gut. The extensive use of broad
spectrum antibiotic therapy kills these normal and useful bacteria, and allow
overgrowth of harmful intestinal infection, a condition called Super-Infection.
Some of these harmful bacteria, so goes the theory, can produce nerve-killing
toxins that enter the brain of a susceptible autistic child, to trigger, cause
or aggravate autistic behavior. Oral Vancomycin could kill that infection,
without being absorbed into systemic circulation (hence unlikely to cause
immediate harm to the child).
A lady in Illinois had an autistic child. The child screamed for hours. He even
chewed drywall from the walls. Complicating matters were severe diarrhea and
other gastrointestinal problems. He had had recurrent ear infections, for which
antibiotics were prescribed shortly before he became autistic at 19 months.
Based on her extensive studies in medical libraries, the mother theorized those
drugs killed Andrew's normal gut-protective bacteria and allowed an intestinal
infection that can produce nerve-killing toxins to enter his brain. Vancomycin,
she thought, could kill that infection.
Based on that hope, she managed to persuade a scientist to try oral vancomycin
in her child to see if it might help her son's severe autism. To their surprise,
the child got better. He was not cured, but all of a sudden he started saying
words and became toilet-trained. The scientists were intrigued as that was not
expected to happen.
So the treatment was extended to eleven more autistic children who, like about a
third of children with this serious brain disorder, also suffer painful
gastrointestinal problems. Neuropsychological testing concluded that 10 children
improved, though only for a while. All the children worsened after just a few months.
However, a little bit of the improvement remained, making it a little easier to
manage them, though the remnant improvement was variable.
Dr. Michael Chez of Chicago plans to compare vancomycin to a dummy drug in a
"Placebo controlled study" to find out if the improvements are genuine
or merely the result of increased attention and care given to the children
during the trial.
Scientists are trying to study whether there is a cause and effect association
between gut bacterial problems and brain function. At present, intense behavior
therapy is autism's only proven treatment. The famous secretin
therapy of autism already seems to be falling by the wayside. Some other nutritional
aids and vitamins provide some help though they are not curative. Will
vancomycin or an allied antibiotic hold a future therapeutic key ? Only more
research will answer the question.
About vancomycin
Vancomycin is a macrolide glycopeptide class of antibiotic. It interacts with
many drugs and may cause kidney, hearing, or balance dysfunction. Its adverse
effects also include the following: skin rash, red neck, flushing, drug fever,
low white blood cell count, increased eosinophil count in blood, allergic shock,
low blood pressure, wheezing, and skin eruptions. Most of these reactions are
seen only during injectable treatment.
Vancomycin is one of our main-stays against multi-drug resistant life
threatening infection with Staphylococcus aureas or antibiotic induced large gut
infection. If it is misused by indiscriminate oral therapy as above, then the
bacteria may become resistant to vancomycin also, and we will have lost another
important battle against drug resistant bacteria.
This is why doctors are still hesitant to prescribe
vancomycin for autism till we have more conclusive data.
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