Multiple-dose activated charcoal in an accidental vancomycin overdose

J Toxicol Clin Toxicol. 1996;34(1):83-6. doi: 10.3109/15563659609020238.


Background: Multiple-dose activated charcoal may enhance the enterocapillary clearance of vancomycin.

Case report: A 17-day-old female neonate born with congenital meningomyelocele and Arnold-Chiari malformation was iatrogenically overdosed with a 500 mg intravenous bolus of vancomycin during a shunt operation. The Red Man's Syndrome developed within minutes, characterized by sudden hypotension, skin rash and cyanosis. Serum vancomycin level at one hour after the injection was 165.7 micrograms/mL, as measured by an enzyme immunoassay method (EMIT). Multiple dose activated charcoal, 1 g/kg, was first given five hours after injection, 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. The neonate's renal function tests and brainstem auditory responses remained normal.

Conclusions: Gastrointestinal dialysis with multiple-dose activated charcoal without cathartics appeared to shorten the elimination half-life of vancomycin.

Publication types

  • Case Reports

MeSH terms

  • Anti-Bacterial Agents / poisoning*
  • Charcoal / administration & dosage*
  • Cyanosis / prevention & control*
  • Drug Eruptions / prevention & control*
  • Drug Overdose
  • Female
  • Humans
  • Hypotension / prevention & control*
  • Infant, Newborn
  • Syndrome
  • Vancomycin / poisoning*


  • Anti-Bacterial Agents
  • Charcoal
  • Vancomycin