Short-Term Benefit From Oral Vancomycin Treatment of Regressive-Onset Autism

• Published in: Journal of child neurology 2000-07, Vol.15 (7), p.429-435
• Main Authors: Sandler, Richard H., Finegold, Sydney M., Bolte, Ellen R., Buchanan, Cathleen P., Maxwell, Anne P., Väisänen, Marja-Liisa, Nelson, Michael N., Wexler, Hannah M.
• Format: Article
• Language: English
• Subjects: Administration, Oral; Autism; Autistic Disorder - diagnosis; Autistic Disorder - drug therapy; Autistic Disorder - microbiology; Bacteria - growth & development; Child; Child, Preschool; Communication (Thought Transfer); Developmental Delays; Dose-Response Relationship, Drug; Drug Administration Schedule; Educational Therapy; Etiology; Feces - microbiology; Female; Humans; Hyperactivity; Interpersonal Competence; Intestinal Mucosa - microbiology; Laboratories; Land Settlement; Literature Reviews; Male; Measurement Techniques; Mental Disorders; Neuropsychological Tests; Organic Chemistry; Play Therapy; Rating Scales; Regression (Psychology); Regression (Statistics); Social Development; Toilet Training; Vancomycin - administration & dosage; Vancomycin - adverse effects; Video Technology
• ISSN: 0883-0738; 1708-8283
• DOI: 10.1177/088307380001500701

In most cases symptoms of autism begin in early infancy. However, a subset of children appears to develop normally until a clear deterioration is observed. Many parents of children with "regressive"-onset autism have noted antecedent antibiotic exposure followed by chronic diarrhea. We speculated that, in a subgroup of children, disruption of indigenous gut flora might promote colonization by one or more neurotoxin-producing bacteria, contributing, at least in part, to their autistic symptomatology. To help test this hypothesis, 11 children with regressive-onset autism were recruited for an intervention trial using a minimally absorbed oral antibiotic. Entry criteria included antecedent broad-spectrum antimicrobial exposure followed by chronic persistent diarrhea, deterioration of previously acquired skills, and then autistic features. Short-term improvement was noted using multiple pre- and post-therapy evaluations. These included coded, paired videotapes scored by a clinical psychologist blinded to treatment status; these noted improvement in 8 of 10 children studied. Unfortunately, these gains had largely waned at follow-up. Although the protocol used is not suggested as useful therapy, these results indicate that a possible gut flora-brain connection warrants further investigation, as it might lead to greater pathophysiologic insight and meaningful prevention or treatment in a subset of children with autism. (J Child Neurol 2000;15:429-435).