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vancomycin

Pronunciation

Generic Name: vancomycin (oral) (VAN koe MYE sin)
Brand Name: FIRST-Vancomycin 25, FIRST-Vancomycin 50, Vancocin HCl Pulvules, Vancocin HCl, Lyphocin, Vancocin, Vancoled

What is vancomycin?

Vancomycin is an antibiotic. Oral (taken by mouth) vancomycin fights bacteria in the intestines.

Vancomycin is used to treat an infection of the intestines caused by Clostridium difficile, which can cause watery or bloody diarrhea. Vancomycin is also used to treat staph infections that can cause inflammation of the colon and small intestines.

Oral vancomycin works only in the intestines. This medicine is not normally absorbed into the body and will not treat other types of infection. An injection form of this medication is available to treat serious infections in other parts of the body.

Vancomycin may also be used for purposes not listed in this medication guide.

What is the most important information I should know about vancomycin?

Oral vancomycin works only in the intestines and will not treat infections in other parts of the body. Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

What should I discuss with my healthcare provider before taking vancomycin?

You should not take this medication if you are allergic to vancomycin.

To make sure vancomycin is safe for you, tell your doctor if you have:

  • an intestinal disorder such as inflammatory bowel disease, Crohn's disease, or ulcerative colitis;

  • kidney disease;

  • hearing problems; or

  • if you are receiving any IV antibiotics.

FDA pregnancy category C. It is not known whether vancomycin will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

Vancomycin can pass into breast milk and may harm a nursing baby. You should not breast-feed while using this medicine.

Side effects on the kidneys may be more likely in older adults taking this medicine.

How should I take vancomycin?

Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Taking more of this medicine will not make it more effective, and may cause serious or life-threatening side effects.

Use this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Vancomycin will not treat a viral infection such as the common cold or flu.

If you use this medication long-term, you may need frequent medical tests at your doctor's office.

Shake the oral suspension (liquid) well just before you measure a dose.

Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

Store vancomycin capsules at room temperature, away from heat and moisture.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while using vancomycin?

Follow your doctor's instructions about any restrictions on food, beverages, or activity.

Vancomycin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Certain side effects may occur if your body absorbs vancomycin through the intestinal walls. Call your doctor at once if you have:

  • increased diarrhea that is watery or bloody;

  • hearing loss, ringing in your ears;

  • kidney problems--swelling, rapid weight gain, pain in your side or lower back, little or no urinating; or

  • low potassium--confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling.

Common side effects may include:

  • nausea; or

  • stomach pain.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Vancomycin dosing information

Usual Adult Dose for Bacterial Infection:

15 to 20 mg/kg IV every 8 to 12 hours (2 to 3 g/day); a loading dose of 25 to 30 mg/kg can be considered for seriously ill patients

The manufacturer recommends 500 mg IV every 6 hours or 1 g IV every 12 hours.

Usual Adult Dose for Bacteremia:

15 to 20 mg/kg IV every 8 to 12 hours
Duration: 2 to 6 weeks, depending on the nature and severity of the infection

Usual Adult Dose for Bacterial Endocarditis Prophylaxis:

For patients allergic to penicillin: 1 g IV once; infusion should be completed within 30 minutes of the start of the procedure

Gentamicin may be added for high-risk patients.

Usual Adult Dose for Endocarditis:

Alternate drug for patients who are unable to tolerate penicillin or ceftriaxone, and for oxacillin-resistant staphylococcal strains: 15 to 20 mg/kg IV every 8 to 12 hours with or without other antibiotics depending on the nature of the infection

Duration:
Native valve: 6 weeks
Prosthetic valve: at least 6 weeks

Maximum dose: 2 g/day unless serum concentrations are low (recommended trough: 15 to 20 mcg/mL)

Refer to current published guidelines for detailed recommendations.

Usual Adult Dose for Pseudomembranous Colitis:

Clostridium difficile associated diarrhea: 125 mg orally 4 times a day for 10 days
Staphylococcal enterocolitis: 500 to 2000 mg/day given orally in 3 or 4 divided doses for 7 to 10 days

Usual Adult Dose for Enterocolitis:

Clostridium difficile associated diarrhea: 125 mg orally 4 times a day for 10 days
Staphylococcal enterocolitis: 500 to 2000 mg/day given orally in 3 or 4 divided doses for 7 to 10 days

Usual Adult Dose for Meningitis:

IV: 15 to 20 mg/kg IV every 8 to 12 hours
Duration: 10 to 14 days or at least 1 week after the patient becomes afebrile and cerebrospinal fluid normalizes

Intraventricular, intrathecal: 5 to 20 mg of a preservative-free formulation have been administered up to every 24 hours

Usual Adult Dose for Nosocomial Pneumonia:

Hospital-acquired: 15 to 20 mg/kg IV every 8 to 12 hours
Recommended trough levels: 15 to 20 mcg/mL

Initial empiric treatment with broad-spectrum coverage according to the hospital's and/or ICU's antibiogram is recommended if multidrug-resistant organisms are suspected.

Duration: The duration of treatment should be as short as clinically possible (e.g., as little as 7 days) to reduce the risk of superinfections with resistant organisms.

Usual Adult Dose for Pneumonia:

Due to methicillin-resistant Staphylococcus aureus (MRSA): 15 to 20 mg/kg IV every 8 to 12 hours
Duration: 7 to 21 days, depending on the nature and severity of the infection

Usual Adult Dose for Osteomyelitis:

15 to 20 mg/kg IV every 8 to 12 hours

Duration: 3 to 6 weeks or at least 8 weeks if due to MRSA; oral antibiotics may be required for chronic osteomyelitis for an additional 1 to 2 months

Usual Adult Dose for Febrile Neutropenia:

15 mg/kg IV every 12 hours

Duration: Once the patient is stable, afebrile for at least 24 hours, and the absolute neutrophil count is greater than 500/mm3, oral antibiotics may be substituted if antibiotic therapy is to be continued.

Usual Adult Dose for Peritonitis:

IV: 15 mg/kg IV every 12 hours
Duration: 14 days, depending on the nature and severity of the infection

Intraperitoneal:
CAPD patients: 15 to 30 mg/kg every 5 to 7 days or 30 to 50 mg/L exchange; dosages may be increased by 25% in nonanuric patients
Duration: 14 to 21 days, depending on the nature and severity of the infection

Usual Adult Dose for Burns - External:

15 mg/kg IV every 12 hours

Usual Adult Dose for Prevention of Perinatal Group B Streptococcal Disease:

If patient has immediate penicillin hypersensitivity and susceptibility is unknown, testing is not possible, or the isolates are resistant to erythromycin or clindamycin: 1 g IV every 12 hours until delivery

Usual Adult Dose for Sepsis:

15 mg/kg IV every 12 hours

Duration: 10 to 14 days, depending on the nature and severity of the infection; longer therapy may be necessary in neutropenic or immunocompromised patients

Usual Adult Dose for Shunt Infection:

IV: 15 to 20 mg/kg IV every 8 to 12 hours (up to 2 to 3 g/day)
Intraventricular: 5 to 20 mg of a preservative-free formulation have been administered up to every 24 hours

Usual Adult Dose for Skin or Soft Tissue Infection:

15 mg/kg IV every 12 hours
Duration: 10 to 14 days, depending on the nature and severity of the infection

Usual Adult Dose for Surgical Prophylaxis:

1 g IV once; infusion should be completed within 30 minutes of the start of the procedure
The dose may be repeated if the procedure lasts longer than 6 hours.

Usual Pediatric Dose for Bacterial Infection:

Less than 7 days, less than 1200 g: 15 mg/kg IV every 24 hours
Less than 7 days, 1200 to 2000 g: 10 to 15 mg/kg IV every 12 to 18 hours
Less than 7 days, greater than 2000 g: 10 to 15 mg/kg IV every 8 to 12 hours

7 days up to 1 month, less than 1200 g: 15 mg/kg IV every 24 hours
7 days up to 1 month, 1200 to 2000 g: 10 to 15 mg/kg IV every 8 to 12 hours
7 days up to 1 month, greater than 2000 g: 10 to 15 mg/kg IV every 6 to 8 hours

1 month to 18 years: 10 to 20 mg/kg IV every 6 to 8 hours (total 40 to 60 mg/kg/day)

The manufacturer recommends an initial dose of 15 mg/kg in neonates, followed by 10 mg/kg every 12 hours for neonates in the first week of life and every 8 hours thereafter up to 1 month of age. The manufacturer recommends 10 mg/kg IV every 6 hours for pediatric patients.

Usual Pediatric Dose for Bacterial Endocarditis Prophylaxis:

1 month or older:
For patients allergic to penicillin: 20 mg/kg IV (maximum 1 g) once; infusion should be completed within 30 minutes of the start of the procedure

Gentamicin 1.5 mg/kg (maximum 120 mg) IV or IM may be added for high-risk patients.

Usual Pediatric Dose for Peritonitis:

CAPD patients: 30 mg/kg intraperitoneally every 5 to 7 days or 30 mg/L exchange

Usual Pediatric Dose for Pseudomembranous Colitis:

1 to 18 years: 40 mg/kg/day orally in 3 or 4 divided doses
Maximum dose: 2 g/day
Duration: 7 to 10 days

Usual Pediatric Dose for Enterocolitis:

1 to 18 years: 40 mg/kg/day orally in 3 or 4 divided doses
Maximum dose: 2 g/day
Duration: 7 to 10 days

Usual Pediatric Dose for Surgical Prophylaxis:

15 mg/kg IV once, with or without gentamicin; infusion should be completed within 30 minutes of the start of the procedure

What other drugs will affect vancomycin?

Other drugs may interact with vancomycin, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your pharmacist can provide more information about vancomycin.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 10.02. Revision Date: 2014-03-27, 11:57:18 AM.

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