Vancomycin
Overview
Vancomycin is a glycopeptide antibiotic active against Gram-positive bacteria, including anaerobes. In the context of hepatobiliary disease, oral vancomycin has been evaluated for its immunomodulatory effects in primary sclerosing cholangitis (PSC), a major risk factor for cholangiocarcinoma (CHOL). Its mechanism in PSC is thought to involve modulation of the gut microbiota with downstream suppression of TH17 responses and restoration of CXCL16-dependent NKT-cell recruitment.
Evidence in the corpus
- Multiple completed and active clinical trials (NCT01322386, NCT01802073, NCT02137668, NCT03710122, NCT06197308) report improved liver function tests (GGT, ALP, ALT normalization rates of 39%/22%/55.9% within 6 months) in PSC patients on oral vancomycin, supporting microbiota modulation as adjuvant therapy in PSC and CCA prevention PMID:25608663
- Caution noted: prolonged broad-spectrum antibiotic use correlates with reduced survival in HCC patients on anti-PD-1 therapy; antibiotic-microbiota strategies require careful sequencing and adjunctive probiotics/FMT to avoid immunotherapy resistance PMID:25608663
Resistance mechanisms
Cancer types (linked)
- CHOL — cholangiocarcinoma / primary sclerosing cholangitis (adjuvant context)
Sources
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