vancomycin

Generic Name: vancomycin (VAN koe MYE sin)
Brand names: Vancocin HCl Pulvules, Vancocin HCl, Lyphocin, Vancocin, Vancoled

What is vancomycin?

Vancomycin is an antibiotic. It fights bacteria in the body.

Vancomycin is used to treat infections of the intestines that cause colitis (inflammation of the large intestine).

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

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

Before using vancomycin, tell your doctor if you are allergic to any drugs, or if you have kidney disease, problems with your hearing, or an intestinal disorder such as inflammatory bowel disease, Crohn's disease, or ulcerative colitis.

Vancomycin can cause temporary or permanent hearing loss. Stop using this medication and call your doctor at once if you have any hearing problems or ringing in your ears.

To be sure this medication is not causing harmful effects, your hearing will need to be tested often. Visit your doctor regularly.

Take this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Vancomycin will not treat a viral infection such as the common cold or flu.

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

Do not take this medication if you are allergic to vancomycin.

To make sure you can safely take vancomycin, tell your doctor if you have any of these other conditions:

• kidney disease,

• hearing problems; or

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

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. Do not take this medication without telling your doctor if you are breast-feeding a baby.

How should I take vancomycin?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Vancomycin can cause temporary or permanent hearing loss. To be sure this medication is not causing harmful effects, your hearing will need to be tested on a regular basis. Do not miss any scheduled visits to your doctor.

Take the oral medicine with a full glass of water.

Vancomycin should be taken at evenly spaced intervals.

Shake the oral suspension (liquid) well just before you measure a dose. Measure the liquid with a special dose-measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one. Take this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Vancomycin will not treat a viral infection such as the common cold or flu. Store vancomycin capsules at room temperature, away from heat and moisture. Store vancomycin oral liquid in the refrigerator, but do not allow it to freeze.

See also: Vancomycin dosage (in more detail)

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?

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, stop taking vancomycin and call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Vancomycin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using vancomycin and call your doctor at once if you have any of these serious side effects:

• hearing loss, ringing in your ears;

• urinating less than usual or not at all;

• fever, chills, body aches, flu symptoms;

• feeling light-headed, fainting;

• skin rash, redness, bruising, severe tingling, numbness, pain, muscle weakness; or

• severe stomach pain, diarrhea that is watery or bloody.

Less serious side effects may include:

• dizziness;

• nausea;

• back pain; or

• muscle pain or tightness.

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: vancomycin 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:

125 mg to 500 mg orally 4 times a day
Duration: 7 to 10 days

Usual Adult Dose for Enterocolitis:

125 mg to 500 mg orally 4 times a day
Duration: 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?

Tell your doctor about all other medicines you use, especially:

• amikacin (Amikin);

• gentamicin (Garamycin);

• kanamycin (Kantrex);

• neomycin (Mycifradin, Neo-Fradin, Neo-Tab);

• streptomycin; or

• tobramycin (Nebcin, Tobi).

This list is not complete and other drugs may interact with vancomycin. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about vancomycin.