Vancomycin
Pronouncation: (van-koe-MY-sin)Class: Anti-infective agent
Trade Names:
Lyphocin
- Powder for injection, lyophilized 500 mg
- Powder for injection, lyophilized 1 g
- Powder for injection, lyophilized 5 g
- Powder for injection, lyophilized 10 g
Trade Names:
Vancocin
- Pulvules 125 mg
- Pulvules 250 mg
- Powder for injection 500 mg
- Powder for injection 10 g
Trade Names:
Vancoled
- Powder for injection 500 mg
- Powder for injection 1 g
- Powder for injection 5 g
Trade Names:
Vancomycin Hydrochloride
- Powder for oral solution 1 g
Pharmacology
Feedback for Vancomycin
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Inhibits bacterial cell wall synthesis and alters cell-membrane permeability and RNA synthesis.
Pharmacokinetics
Absorption
Poorly absorbed (orally). C max is 63 mcg/mL. T max is 1 h.
Distribution
55% protein bound. Vd is 0.3 to 0.43 L/kg. Distributes to pleural, pericardial, ascitic, and synovial fluids; in urine; in peritoneal dialysis fluid; and atrial appendage tissue.
Metabolism
No apparent metabolism of the drug.
Elimination
Mean t ½ is 4 to 6 h. 75% is excreted in urine by glomerular filtration (in the first 24 h). Mean plasma Cl is 0.058 L/kg/h. Renal Cl is 0.048 L/kg/h.
Special Populations
Renal Function ImpairmentRenal function impairment slows excretion of vancomycin in anephric patients, t ½ is 7.5 days.
ElderlyTotal systemic and renal Cl may be reduced.
Indications and Usage
ParenteralTreatment of serious or severe infections due to susceptible bacteria not treatable with other antimicrobials (eg, staphylococcus).
OralTreatment of pseudomembranous colitis caused by Clostridium difficile ; treatment of staphylococcal enterocolitis.
Unlabeled Uses
IV prophylaxis against bacterial endocarditis in penicillin-allergic patients.
Contraindications
Standard considerations.
Dosage and Administration
AdultsPO 500 mg to 2 g/day in 3 or 4 divided doses for 7 to 10 days.
ChildrenPO 40 mg/kg/day (up to 2ߙg/day) in 3 or 4 divided doses for 7 to 10 days.
NewbornsPO 10 mg/kg/day in divided doses.
AdultsIV 500 mg by IV infusion every 6 h or 1 g every 12 h.
ChildrenIV 10 mg/kg/dose every 6 h.
Infants & NewbornsIV 15 mg/kg initially, followed by 10 mg/kg every 12 h for newborns in first week of life, and every 8 h for ages up to 1 mo.
General Advice
- Prepare oral solution by adding 115 mL of water to 10 g vial or 20 mL of water to 1 g vial. Further dilute prepared oral solution dose with 30ߙmL of water or flavoring syrups may be used with oral solution.
- May give oral solution via nasogastric tube as indicated or ordered.
- Reconstitute parenteral form with sterile water for injection.
- Further dilute parenteral medication with compatible solution (eg, dextrose injection 5%, sodium chloride 0.9%, lactated Ringer's).
- Parenteral form may be administered by oral route.
- Reconstituted oral solution may be stored in refrigerator for 2 wk after bottle is opened.
- Dilute to minimum dilution of 2.5 mL and infuse parenteral solution over at least 60 min. Intermittent infusion preferred.
- Pretreat with antihistamine if patient has previously experienced Red Man Syndrome.
- Dosage or dosage interval may be changed based upon vancomycin serum levels.
- Reconstituted powder for injection is stable at room temperature for 2 wk.
- Dilute solutions (sodium chloride or D5W) are stable at room temperature for 24 h.
Drug Interactions
AminoglycosidesMay increase risk of nephrotoxicity.
Neurotoxic and nephrotoxic agentsMay give additive toxicity.
Nondepolarizing muscle relaxantsNeuromuscular blockade may be enhanced.
Incompatibility
IV solution is incompatible with alkaline injections.
Laboratory Test Interactions
None well documented.
Adverse Reactions
Cardiovascular
Hypotension.
Dermatologic
Rash; urticaria; pruritus; inflammation at site of injection.
EENT
Hearing loss.
GI
Nausea.
Genitourinary
Increased serum creatinine and BUN; renal failure.
Hematologic
Neutropenia; eosinophilia.
Respiratory
Wheezing; dyspnea.
Miscellaneous
Anaphylaxis; drug fever; chills; Red Man Syndrome (hypotension with or without rash over face, neck, upper chest, and extremities).
Precautions
Pregnancy
Category C .
Lactation
Excreted in breast milk.
Children
Confirming serum levels may be appropriate in newborns. Use of vancomycin with anesthetics may cause erythema and flushing.
Special Risk Patients
Use with caution in patients with preexisting hearing loss, patients receiving ototoxic or nephrotoxic drugs, patients receiving drugs that cause neutropenia; patients with renal function impairment; elderly; newborns.
Hypotension
Too rapid IV infusion or bolus administration may be associated with exaggerated hypotension, including shock and cardiac arrest, with or without maculopapular rash over face, neck, upper chest, and extremities (Red Man or Redneck syndrome). Reaction has been rarely associated with slow infusion or oral or intraperitoneal administration.
Reversible neutropenia
May occur after total dose of 25 g.
Tissue irritation, thrombophlebitis
Give by secure IV route. May minimize thrombophlebitis by giving slowly as dilute infusion.
Overdosage
Symptoms
Increase serum creatinine, increase BUN, hearing loss, ringing in ears, vertigo.
Patient Information
- Explain that IV medication is given at regular intervals to maintain blood levels.
- Tell patient to report hearing loss, ringing in ears, or vertigo to health care provider.
- Explain signs of superinfection (eg, vaginitis).
- Identify symptoms of potential adverse reactions.
- Tell patient to maintain adequate fluid intake.
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More Vancomycin resources:
Vancomycin - Includes detailed dosage instructions.
Bacterial Infection, Skin Infection, Pneumonia, Bacterial Endocarditis Prevention, Bone infection, Meningitis, Febrile Neutropenia, Surgical Prophylaxis, Peritonitis, Bacteremia, Nosocomial Pneumonia, Endocarditis, Sepsis, Prevention of Perinatal Group B Streptococcal Disease, Pseudomembranous Colitis, Enterocolitis, Burns - External, Shunt Infection
