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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

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:

500 mg IV every 6 hours OR 1 g IV every 12 hours

Comments:
-This drug should be administered at a rate up to 10 mg/min or over 1 hour, whichever is longer.
-Doses should be determined by patient-specific factors (e.g., obesity, age).

Use:
-Empirical treatment of serious/severe staphylococcal infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs

Infectious Diseases Society of America (IDSA) Recommendations:
15 mg/kg IV every 12 hours

Comments:
-Treatment plus an aminoglycoside should be used for ampicillin-resistant, vancomycin-sensitive Enterococcus faecalis/Enterococcus faecium.

Uses:
-Preferred treatment for IV catheter-related bloodstream infections caused by methicillin-resistant Staphylococcus aureus (MRSA)/coagulase-negative staphylococci, ampicillin-resistant, vancomycin-sensitive E faecalis/E faecium, Corynebacterium jeikeium (group JK)
-Alternative treatment for IV catheter-related bloodstream infections caused by methicillin-susceptible S aureus (MSSA)/coagulase-negative staphylococci, ampicillin-susceptible E faecalis/E faecium

Usual Adult Dose for Endocarditis:

500 mg IV every 6 hours OR 1 g IV every 12 hours

Comments:
-This drug should be administered at a rate up to 10 mg/min or over 1 hour, whichever is longer.
-Doses should be determined by patient-specific factors (e.g., obesity, age).
-Successful treatment of diphtheroid endocarditis has been reported.

Uses:
-Empirical treatment of staphylococcal endocarditis caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs
-Empirical treatment (with an aminoglycoside) of endocarditis caused by enterococci, Streptococcus bovis, or Streptococcus viridans
-Empirical treatment (with an aminoglycoside and/or rifampin) of early-onset prosthetic valve endocarditis caused by Staphylococcus epidermidis or diphtheroids

American Heart Association (AHA) and IDSA Recommendations:
15 to 20 mg/kg per day IV every 8 to 12 hours
-Maximum dose: 2 g/dose

Duration of treatment:
-Native Valve Endocarditis: At least 4 weeks
-Prosthetic Valve Endocarditis: At least 6 weeks

Comments:
-Patients may not require the addition of gentamicin or rifampin.
-Patients with native valve endocarditis caused by oxacillin-resistant staphylococci may require at least 6 weeks of treatment.

Uses:
-Treatment of endocarditis caused by highly penicillin-susceptible and relatively resistant to penicillin viridans group streptococci (VGS) and Streptococcus gallolyticus (bovis) in patients who cannot tolerate penicillin or ceftriaxone
-Treatment of endocarditis involving a prosthetic value/other prosthetic material caused by VGS and S gallolyticus (bovis)
-Alternative treatment of endocarditis caused by oxacillin-resistant staphylococci in patients with immediate-type hypersensitivity to beta-lactam antibiotics
-Treatment of penicillin-resistant endocarditis caused by enterococci in patients unable to tolerate beta-lactam antibiotics

Usual Adult Dose for Pseudomembranous Colitis:

Clostridium difficile-associated diarrhea: 125 mg orally 4 times a day
-Duration of therapy: 10 days

Enterocolitis: 500 mg to 2 g orally in 3 to 4 divided doses
-Maximum dose: 2 g/day
-Duration of therapy: 7 to 10 days

Comment: Formulations administered parenterally will not treat colitis.

Uses:
-Treatment of C difficile-associated diarrhea
-Treatment of enterocolitis caused by S aureus (including MRSA)

Society of Healthcare Epidemiology of America (SHEA) and IDSA Recommendations:
Initial treatment of severe C difficile infection (CDI): 125 mg orally 4 times a day
-Duration of therapy: 10 to 14 days

Severe, complicated CDI: 500 mg orally 4 times a day AND 500 mg (in 100 mL normal saline) rectally every 6 hours with/without IV metronidazole

Comments:
-Rectal formulations should be administered as a retention enema.
-The first recurrence of CDI may be treated with the initial treatment regimen; a second recurrence of CDI may be treated with a tapered/pulsed regimen of this drug.

Uses:
-Initial treatment of patients with severe CDI
-Initial treatment of patients with complicated, severe CDI

Usual Adult Dose for Enterocolitis:

Clostridium difficile-associated diarrhea: 125 mg orally 4 times a day
-Duration of therapy: 10 days

Enterocolitis: 500 mg to 2 g orally in 3 to 4 divided doses
-Maximum dose: 2 g/day
-Duration of therapy: 7 to 10 days

Comment: Formulations administered parenterally will not treat colitis.

Uses:
-Treatment of C difficile-associated diarrhea
-Treatment of enterocolitis caused by S aureus (including MRSA)

Society of Healthcare Epidemiology of America (SHEA) and IDSA Recommendations:
Initial treatment of severe C difficile infection (CDI): 125 mg orally 4 times a day
-Duration of therapy: 10 to 14 days

Severe, complicated CDI: 500 mg orally 4 times a day AND 500 mg (in 100 mL normal saline) rectally every 6 hours with/without IV metronidazole

Comments:
-Rectal formulations should be administered as a retention enema.
-The first recurrence of CDI may be treated with the initial treatment regimen; a second recurrence of CDI may be treated with a tapered/pulsed regimen of this drug.

Uses:
-Initial treatment of patients with severe CDI
-Initial treatment of patients with complicated, severe CDI

Usual Adult Dose for Pneumonia:

500 mg IV every 6 hours OR 1 g IV every 12 hours

Comments:
-This drug should be administered at a rate up to 10 mg/min or over 1 hour, whichever is longer.
-Doses should be determined by patient-specific factors (e.g., obesity, age).

Use: Empirical treatment of lower respiratory tract infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs

IDSA Recommendations:
15 mg/kg IV every 8 to 12 hours
-Some experts recommend a loading dose of 25 to 30 mg/kg IV once (severe illness)

Uses:
-Empiric treatment of clinically suspected ventilator-associated pneumonia where MRSA coverage is appropriate
-Add-on empiric treatment of hospital-acquired pneumonia in patients not at high risk of mortality but with MRSA risk factors
-Add-on empiric treatment of hospital-acquired pneumonia in patients at high risk of mortality or with receipt of IV antibiotics within the previous 90 days

Usual Adult Dose for Nosocomial Pneumonia:

500 mg IV every 6 hours OR 1 g IV every 12 hours

Comments:
-This drug should be administered at a rate up to 10 mg/min or over 1 hour, whichever is longer.
-Doses should be determined by patient-specific factors (e.g., obesity, age).

Use: Empirical treatment of lower respiratory tract infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs

IDSA Recommendations:
15 mg/kg IV every 8 to 12 hours
-Some experts recommend a loading dose of 25 to 30 mg/kg IV once (severe illness)

Uses:
-Empiric treatment of clinically suspected ventilator-associated pneumonia where MRSA coverage is appropriate
-Add-on empiric treatment of hospital-acquired pneumonia in patients not at high risk of mortality but with MRSA risk factors
-Add-on empiric treatment of hospital-acquired pneumonia in patients at high risk of mortality or with receipt of IV antibiotics within the previous 90 days

Usual Adult Dose for Osteomyelitis:

500 mg IV every 6 hours OR 1 g IV every 12 hours

Comments:
-This drug should be administered at a rate up to 10 mg/min or over 1 hour, whichever is longer.
-Doses should be determined by patient-specific factors (e.g., obesity, age).

Use: Empirical treatment of bone infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs

IDSA Recommendations:
15 to 20 mg/kg IV every 12 hours
-Duration of therapy: 4 to 6 weeks

Uses:
-First choice treatment for native vertebral osteomyelitis caused by oxacillin-resistant staphylococci, penicillin-resistant Enterococcus species
-Alternative treatment for native vertebral osteomyelitis caused by oxacillin-susceptible staphylococci
-Alternative treatment for native vertebral osteomyelitis caused by penicillin-susceptible Enterococcus species, Enterobacteriaceae, beta-hemolytic streptococci, or Propionibacterium acnes in patients allergic to penicillin

Usual Adult Dose for Sepsis:

500 mg IV every 6 hours OR 1 g IV every 12 hours

Comments:
-This drug should be administered at a rate up to 10 mg/min or over 1 hour, whichever is longer.
-Doses should be determined by patient-specific factors (e.g., obesity, age).

Use: Empirical treatment of septicemia caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs

Usual Adult Dose for Skin or Soft Tissue Infection:

500 mg IV every 6 hours OR 1 g IV every 12 hours

Comments:
-This drug should be administered at a rate up to 10 mg/min or over 1 hour, whichever is longer.
-Doses should be determined by patient-specific factors (e.g., obesity, age).

Use: Empirical treatment of skin and skin structure infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs

IDSA Recommendations:
15 mg/kg IV every 6 to 12 hours

Comment: Multidrug resistant organisms may require daily doses up to 60 mg/kg.

Uses:
-First-line treatment of treatment of skin and soft tissue infections (SSTIs) caused by MRSA in patients who require parenteral treatment
-Alternative treatment of SSTIs in patients with penicillin allergies
-Treatment of incisional surgical site infections of the lower trunk or extremity away from the axilla/perineum
-First-line treatment of necrotizing infections of the skin, fascia, and muscle caused by mixed infections

Usual Adult Dose for Bacteremia:

IDSA Recommendations:
15 to 20 mg/kg IV every 8 to 12 hours
-Duration of treatment: Up to 6 weeks, depending on the severity of infection

Use: Treatment of bacteremia

Usual Adult Dose for Meningitis:

IDSA, American Academy of Neurology (AAN), American Association of Neurological Surgeons (AANS), and Neurocritical Care Society (NCS) Recommendations:
30 to 60 mg/kg IV per day, given in divided doses every 8 to 12 hours
-Some experts recommend: 15 mg/kg IV once, followed by 60 mg/kg per day continuous infusion
-Maximum dose: 2 g/dose
-Duration of treatment: At least 2 weeks

Comment: Surgical evaluation is recommended for patients with septic thromboses, empyema, and/or abscesses.

Uses:
-Treatment of patients with healthcare-associated ventriculitis and meningitis caused by methicillin-resistant staphylococci
-In combination with a third-generation cephalosporin, treatment of patients with healthcare-associated ventriculitis and meningitis caused by Streptococcus pneumoniae
-Alternative treatment of patients with healthcare-associated ventriculitis and meningitis caused by methicillin-sensitive staphylococci or P acnes
-Treatment of patients with brain abscess, subdural empyema, and/or spinal epidural abscess
-Treatment of patients with septic thrombosis of cavernous/Dural venous sinus

Usual Adult Dose for CNS Infection:

IDSA, American Academy of Neurology (AAN), American Association of Neurological Surgeons (AANS), and Neurocritical Care Society (NCS) Recommendations:
30 to 60 mg/kg IV per day, given in divided doses every 8 to 12 hours
-Some experts recommend: 15 mg/kg IV once, followed by 60 mg/kg per day continuous infusion
-Maximum dose: 2 g/dose
-Duration of treatment: At least 2 weeks

Comment: Surgical evaluation is recommended for patients with septic thromboses, empyema, and/or abscesses.

Uses:
-Treatment of patients with healthcare-associated ventriculitis and meningitis caused by methicillin-resistant staphylococci
-In combination with a third-generation cephalosporin, treatment of patients with healthcare-associated ventriculitis and meningitis caused by Streptococcus pneumoniae
-Alternative treatment of patients with healthcare-associated ventriculitis and meningitis caused by methicillin-sensitive staphylococci or P acnes
-Treatment of patients with brain abscess, subdural empyema, and/or spinal epidural abscess
-Treatment of patients with septic thrombosis of cavernous/Dural venous sinus

Usual Adult Dose for Febrile Neutropenia:

National Comprehensive Cancer Network (NCCN) Recommendations:
15 mg/kg IV every 12 hours

Comments:
-This drug should not be used as routine therapy for febrile neutropenia.
-Empiric therapy should be reassessed within 2 to 3 days of initiation. If gram-positive organisms are not found, discontinuation of treatment should be considered.
-Patients with resolved fever and neutrophil counts of at least 500 cells/mcL may discontinue therapy.

Use: Empiric prophylaxis in patients at high-risk for febrile neutropenia caused by serious gram-positive infections

Usual Adult Dose for Intraabdominal Infection:

Surgical Infection Society (SIS) and IDSA Recommendations:
15 to 20 mg/kg IV every 8 to 12 hours

Comment: Initial doses should be determined by total body weight.

Uses:
-Empiric treatment of complicated intra-abdominal infections
-Treatment of peritonitis caused by enterococci species or MRSA

International Society for Peritoneal Dialysis (ISPD) Recommendations:
Intermittent: 15 to 30 mg/kg intraperitoneally every 5 to 7 days

Duration of therapy:
-Enterococcal peritonitis: 3 weeks
-Culture-negative peritonitis: 2 weeks

Use: Treatment of bacterial peritonitis

Usual Adult Dose for Peritonitis:

Surgical Infection Society (SIS) and IDSA Recommendations:
15 to 20 mg/kg IV every 8 to 12 hours

Comment: Initial doses should be determined by total body weight.

Uses:
-Empiric treatment of complicated intra-abdominal infections
-Treatment of peritonitis caused by enterococci species or MRSA

International Society for Peritoneal Dialysis (ISPD) Recommendations:
Intermittent: 15 to 30 mg/kg intraperitoneally every 5 to 7 days

Duration of therapy:
-Enterococcal peritonitis: 3 weeks
-Culture-negative peritonitis: 2 weeks

Use: Treatment of bacterial peritonitis

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

US CDC Recommendations:
1 g IV every 12 hours until delivery

Use: Prevention of early-onset group B streptococcal disease in patients with penicillin hypersensitivity and susceptibility is unknown/not possible or the isolates are resistant to erythromycin or clindamycin

Usual Adult Dose for Shunt Infection:

IDSA, AAN, AANS, and NCS Recommendations:
Patients with slit ventricles: 5 mg via intraventricular route (plus gentamicin)
Patients with normal-sized ventricles: 10 mg via intraventricular route (plus gentamicin)
Patients with enlarged ventricles: 15 to 20 mg via intraventricular route (plus gentamicin)

Frequency of dosing:
-External drain output less than 50 mL/day: every 3 days
-External drain output 50 to 100 mL/day: every 2 days
-External drain output 100 to 150 mL/day: once a day
-External drain output 150 to 200 mL/day: increase the dose by 5 mg (plus gentamicin) and give once a day
-External drain output 200 to 250 mL/day: increase the dose by 10 mg (plus gentamicin) and give once a day

Use: Treatment of healthcare-associated ventriculitis and meningitis in patients who respond poorly to systemic antibiotics

Usual Adult Dose for Surgical Prophylaxis:

American Society of Health-System Pharmacists (ASHP), IDSA, SHEA, and SIS Recommendations:
15 mg/kg IV once, within 120 minutes before surgery

Uses:
Alternative agent for surgical prophylaxis in patients who have a beta-lactam allergy and are undergoing:
-Cardiac procedures (e.g., coronary artery bypass, cardiac device insertion, ventricular assist devices)
-Neurosurgery (e.g., elective craniotomy and cerebrospinal fluid-shunting procedures, implantation of intrathecal pumps)
-Thoracic procedures (e.g., lobectomy, pneumonectomy, lung resection, thoracotomy, or video-assisted thorascopic surgery)
-Some orthopedic procedures (e.g., spinal procedures without instrumentation, hip fracture repair)
-Some urologic procedures (e.g., clean surgery without entry into urinary tract)
-Heart, lung, and heart-lung transplantation procedures (e.g., heart transplantation, lung and heart-lung transplantation)
-Clean-contaminated or clean plastic surgery procedures with risk factors

Alternative agent (in combination with an aminoglycoside, aztreonam, or fluoroquinolone) for surgical prophylaxis in patients who have a beta-lactam allergy and are undergoing:
-Gastroduodenal procedures (e.g., procedures involving entry in to the lumen of the gastrointestinal tract or procedures not entering the GI tract in high-risk patients)
-Some urologic procedures (e.g., clean surgery involving implanted prosthesis)

Usual Adult Dose for Head Injury:

Armed Forces Infectious Disease Society (AFIDS), SIS, and IDSA Recommendations:
1 g IV every 12 hours plus ciprofloxacin
-Duration of therapy: 5 days OR until cerebrospinal fluid leak is closed, whichever is longer

Use: Antimicrobial prophylaxis for patients with penicillin allergies who have a penetrating brain or spinal cord injury

Usual Pediatric Dose for Bacteremia:

Neonates:
Initial dose: 15 mg/kg IV once

Maintenance dose:
-First week of life: 10 mg/kg IV every 12 hours
-After first week of life: 10 mg/kg IV every 8 hours

1 month or older: 10 mg/kg IV every 6 hours


Comments:
-This drug should be infused over 1 hour.
-Premature infants may require longer dosing intervals.
-Doses should be determined by patient-specific factors (e.g., obesity, age).

Uses:
-Empirical treatment of serious/severe staphylococcal infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs
-Empirical treatment of septicemia caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs
-Empirical treatment of bone infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs

IDSA Recommendations:
Bacteremia:
15 mg/kg IV every 6 hours
-Duration of therapy: 2 to 6 weeks, depending on the severity of infection

Bacterial Infection:
7 days or less and less than 1200 g: 15 mg/kg IV every 24 hours
7 days or less than 1200 to 2000 g: 10 to 15 mg/kg IV every 12 to 18 hours
7 days or less than greater than 2000 g: 10 to 15 mg/kg IV every 8 to 12 hours

8 to 30 days and less than 1200 g: 15 mg/kg IV every 24 hours
8 to 30 days and 1200 to 2000 g: 10 to 15 mg/kg IV every 8 to 12 hours
8 to 30 days and greater than 2000 g: 15 to 20 mg/kg IV every 8 hours

1 month to 18 years: 10 to 13.33 mg/kg IV every 6 to 8 hours
-Maximum dose: 40 mg/kg/day

Uses:
-Preferred treatment for IV catheter-related bloodstream infections caused by MRSA/coagulase-negative staphylococci, ampicillin-resistant, vancomycin-sensitive E faecalis/E faecium, C jeikeium (group JK)
-Alternative treatment for IV catheter-related bloodstream infections caused by MSSA/coagulase-negative staphylococci, ampicillin susceptible E faecalis/E faecium
-Treatment of bacteremia

Usual Pediatric Dose for Osteomyelitis:

Neonates:
Initial dose: 15 mg/kg IV once

Maintenance dose:
-First week of life: 10 mg/kg IV every 12 hours
-After first week of life: 10 mg/kg IV every 8 hours

1 month or older: 10 mg/kg IV every 6 hours


Comments:
-This drug should be infused over 1 hour.
-Premature infants may require longer dosing intervals.
-Doses should be determined by patient-specific factors (e.g., obesity, age).

Uses:
-Empirical treatment of serious/severe staphylococcal infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs
-Empirical treatment of septicemia caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs
-Empirical treatment of bone infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs

IDSA Recommendations:
Bacteremia:
15 mg/kg IV every 6 hours
-Duration of therapy: 2 to 6 weeks, depending on the severity of infection

Bacterial Infection:
7 days or less and less than 1200 g: 15 mg/kg IV every 24 hours
7 days or less than 1200 to 2000 g: 10 to 15 mg/kg IV every 12 to 18 hours
7 days or less than greater than 2000 g: 10 to 15 mg/kg IV every 8 to 12 hours

8 to 30 days and less than 1200 g: 15 mg/kg IV every 24 hours
8 to 30 days and 1200 to 2000 g: 10 to 15 mg/kg IV every 8 to 12 hours
8 to 30 days and greater than 2000 g: 15 to 20 mg/kg IV every 8 hours

1 month to 18 years: 10 to 13.33 mg/kg IV every 6 to 8 hours
-Maximum dose: 40 mg/kg/day

Uses:
-Preferred treatment for IV catheter-related bloodstream infections caused by MRSA/coagulase-negative staphylococci, ampicillin-resistant, vancomycin-sensitive E faecalis/E faecium, C jeikeium (group JK)
-Alternative treatment for IV catheter-related bloodstream infections caused by MSSA/coagulase-negative staphylococci, ampicillin susceptible E faecalis/E faecium
-Treatment of bacteremia

Usual Pediatric Dose for Bacterial Infection:

Neonates:
Initial dose: 15 mg/kg IV once

Maintenance dose:
-First week of life: 10 mg/kg IV every 12 hours
-After first week of life: 10 mg/kg IV every 8 hours

1 month or older: 10 mg/kg IV every 6 hours


Comments:
-This drug should be infused over 1 hour.
-Premature infants may require longer dosing intervals.
-Doses should be determined by patient-specific factors (e.g., obesity, age).

Uses:
-Empirical treatment of serious/severe staphylococcal infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs
-Empirical treatment of septicemia caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs
-Empirical treatment of bone infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs

IDSA Recommendations:
Bacteremia:
15 mg/kg IV every 6 hours
-Duration of therapy: 2 to 6 weeks, depending on the severity of infection

Bacterial Infection:
7 days or less and less than 1200 g: 15 mg/kg IV every 24 hours
7 days or less than 1200 to 2000 g: 10 to 15 mg/kg IV every 12 to 18 hours
7 days or less than greater than 2000 g: 10 to 15 mg/kg IV every 8 to 12 hours

8 to 30 days and less than 1200 g: 15 mg/kg IV every 24 hours
8 to 30 days and 1200 to 2000 g: 10 to 15 mg/kg IV every 8 to 12 hours
8 to 30 days and greater than 2000 g: 15 to 20 mg/kg IV every 8 hours

1 month to 18 years: 10 to 13.33 mg/kg IV every 6 to 8 hours
-Maximum dose: 40 mg/kg/day

Uses:
-Preferred treatment for IV catheter-related bloodstream infections caused by MRSA/coagulase-negative staphylococci, ampicillin-resistant, vancomycin-sensitive E faecalis/E faecium, C jeikeium (group JK)
-Alternative treatment for IV catheter-related bloodstream infections caused by MSSA/coagulase-negative staphylococci, ampicillin susceptible E faecalis/E faecium
-Treatment of bacteremia

Usual Pediatric Dose for Sepsis:

Neonates:
Initial dose: 15 mg/kg IV once

Maintenance dose:
-First week of life: 10 mg/kg IV every 12 hours
-After first week of life: 10 mg/kg IV every 8 hours

1 month or older: 10 mg/kg IV every 6 hours


Comments:
-This drug should be infused over 1 hour.
-Premature infants may require longer dosing intervals.
-Doses should be determined by patient-specific factors (e.g., obesity, age).

Uses:
-Empirical treatment of serious/severe staphylococcal infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs
-Empirical treatment of septicemia caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs
-Empirical treatment of bone infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs

IDSA Recommendations:
Bacteremia:
15 mg/kg IV every 6 hours
-Duration of therapy: 2 to 6 weeks, depending on the severity of infection

Bacterial Infection:
7 days or less and less than 1200 g: 15 mg/kg IV every 24 hours
7 days or less than 1200 to 2000 g: 10 to 15 mg/kg IV every 12 to 18 hours
7 days or less than greater than 2000 g: 10 to 15 mg/kg IV every 8 to 12 hours

8 to 30 days and less than 1200 g: 15 mg/kg IV every 24 hours
8 to 30 days and 1200 to 2000 g: 10 to 15 mg/kg IV every 8 to 12 hours
8 to 30 days and greater than 2000 g: 15 to 20 mg/kg IV every 8 hours

1 month to 18 years: 10 to 13.33 mg/kg IV every 6 to 8 hours
-Maximum dose: 40 mg/kg/day

Uses:
-Preferred treatment for IV catheter-related bloodstream infections caused by MRSA/coagulase-negative staphylococci, ampicillin-resistant, vancomycin-sensitive E faecalis/E faecium, C jeikeium (group JK)
-Alternative treatment for IV catheter-related bloodstream infections caused by MSSA/coagulase-negative staphylococci, ampicillin susceptible E faecalis/E faecium
-Treatment of bacteremia

Usual Pediatric Dose for Endocarditis:

Neonates:
Initial dose: 15 mg/kg IV once

Maintenance dose:
-First week of life: 10 mg/kg IV every 12 hours
-After first week of life: 10 mg/kg IV every 8 hours

1 month or older: 10 mg/kg IV every 6 hours

Comments:
-This drug should be infused over 1 hour.
-Premature infants may require longer dosing intervals.
-Doses should be determined by patient-specific factors (e.g., obesity, age).
-Successful treatment of diphtheroid endocarditis has been reported.

Use:
-Empirical treatment of staphylococcal endocarditis caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs
-Empirical treatment (with an aminoglycoside) of endocarditis caused by enterococci, S bovis, or S viridans
-Empirical treatment (with an aminoglycoside and/or rifampin) of early-onset prosthetic valve endocarditis caused by S epidermidis or diphtheroids

AHA Recommendations: 40 to 60 mg/kg IV every 6 to 12 hours
-Maximum dose: 2 g/day

Duration of therapy:
-Empirical treatment: 4 to 6 weeks
-Staphylococci infection: 6 weeks

Comment: Gentamycin should be added to patients with enterococci infections.

Uses:
-Treatment of native valve and prosthetic valve infective endocarditis
-Empirical alternative treatment (with gentamicin) of community-acquired native valve or late prosthetic valve (over 1 year after surgery) endocarditis
-Empirical treatment of nosocomial endocarditis associated with vascular cannulae or early prosthetic valve endocarditis (1 year or less after surgery)
-Alternative treatment for streptococcal infections highly susceptible to penicillin G (e.g., groups A, B, C, G nonenterococcal, group D streptococci) and streptococci relatively resistant to penicillin (e.g., enterococci, less-susceptible S viridans)
-Alternative treatment for endocarditis caused by S aureus or coagulase-negative staphylococci susceptible or resistant to penicillin G and/or oxacillin in patients highly allergic to beta-lactam antibiotics

Usual Pediatric Dose for Pseudomembranous Colitis:

Safety and efficacy have not been established in patients younger than 18 years of age.

The manufacturer recommends: 40 mg/kg orally in 3 to 4 divided doses
-Maximum dose: 2 g/day
-Duration of therapy: 7 to 10 days

Comment: Formulations administered parenterally will not treat colitis.

Uses:
-Treatment of C difficile-associated diarrhea
-Treatment of enterocolitis caused by S aureus (including MRSA)

Usual Pediatric Dose for Enterocolitis:

Safety and efficacy have not been established in patients younger than 18 years of age.

The manufacturer recommends: 40 mg/kg orally in 3 to 4 divided doses
-Maximum dose: 2 g/day
-Duration of therapy: 7 to 10 days

Comment: Formulations administered parenterally will not treat colitis.

Uses:
-Treatment of C difficile-associated diarrhea
-Treatment of enterocolitis caused by S aureus (including MRSA)

Usual Pediatric Dose for Skin or Soft Tissue Infection:

Less than 7 days:
-Initial dose: 15 mg/kg IV once
-Maintenance dose: 10 mg/kg IV every 12 hours

7 to 30 days:
-Initial dose: 15 mg/kg IV once
-Maintenance dose: 10 mg/kg IV every 8 hours

1 month and older: 10 mg/kg IV every 6 hours

Comments:
-This drug should be administered over 1 hour.
-Premature infants may require a longer dosing interval.
-Doses should be determined by patient-specific factors (e.g., obesity, age).

Use:
-Empirical treatment of skin and skin structure infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs

The IDSA recommends:
10 to 15 mg/kg IV 3 to 4 times a day

Comments:
-Patients with necrotizing infections may require up to a 13 mg/kg dose given IV every 8 hours plus piperacillin.
-Patients with necrotizing infections caused by resistant Staphylococcus aureus may require 15 mg/kg given IV every 6 hours.

Use:
-First-line treatment of treatment of skin and soft tissue infections (SSTIs) caused by MRSA in patients who require parenteral treatment
-Alternative treatment of SSTIs in patients with penicillin allergies
-First-line treatment of necrotizing infections of the skin, fascia, and muscle caused by mixed infections

Usual Pediatric Dose for Pneumonia:

Neonates:
Initial dose: 15 mg/kg IV once

Maintenance dose:
-First week of life: 10 mg/kg IV every 12 hours
-After first week of life: 10 mg/kg IV every 8 hours

1 month or older: 10 mg/kg IV every 6 hours

Comments:
-This drug should be administered over 1 hour.
-Premature infants may require a longer dosing interval.
-Doses should be determined by patient-specific factors (e.g., obesity, age).

Use: Empirical treatment of lower respiratory tract infections caused by susceptible strains of methicillin-resistant staphylococci in patients who are allergic to penicillin, failed to respond/cannot receive other drugs (e.g., penicillins, cephalosporins), and/or to treat organisms that are resistant to other drugs

Pediatric Infectious Diseases Society (PIDS) and IDSA Recommendations:
10 to 20 mg/kg every 6 to 8 hours

Uses:
-Alternative treatment of community acquired pneumonia caused by S pneumoniae with penicillin MICs of less than or equal to 2 mcg/mL, S pneumoniae resistant to penicillin (MICs at least 4 mcg/mL), Group A Streptococcus, or MSSA
-Preferred treatment of community acquired pneumonia caused by MRSA (with/without susceptibility to clindamycin)

Usual Pediatric Dose for Intraabdominal Infection:

SIS and IDSA Recommendations:
40 mg/kg IV per day, divided and given every 6 to 8 hours

Comment: This drug should be given as a 1 hour infusion.

Uses:
-Treatment of complicated intra-abdominal infections
-Treatment of peritonitis caused by Enterococci species or MRSA

ISPD Recommendations:
Prophylaxis: 25 mg/L intraperitoneally once

Treatment: 30 mg/kg intraperitoneally once, then 15 mg/kg intraperitoneally every 3 to 5 days

Uses:
-Prophylaxis against peritonitis in patients with known MRSA colonization at risk of touch contamination during instillation of peritoneal dialysis fluid after system disconnection OR disconnection during peritoneal dialysis
-Treatment of bacterial peritonitis

Usual Pediatric Dose for Peritonitis:

SIS and IDSA Recommendations:
40 mg/kg IV per day, divided and given every 6 to 8 hours

Comment: This drug should be given as a 1 hour infusion.

Uses:
-Treatment of complicated intra-abdominal infections
-Treatment of peritonitis caused by Enterococci species or MRSA

ISPD Recommendations:
Prophylaxis: 25 mg/L intraperitoneally once

Treatment: 30 mg/kg intraperitoneally once, then 15 mg/kg intraperitoneally every 3 to 5 days

Uses:
-Prophylaxis against peritonitis in patients with known MRSA colonization at risk of touch contamination during instillation of peritoneal dialysis fluid after system disconnection OR disconnection during peritoneal dialysis
-Treatment of bacterial peritonitis

Usual Pediatric Dose for Surgical Prophylaxis:

ASHP, IDSA, SHEA, and SIS Recommendations:
15 mg/kg IV once, within 120 minutes before surgery

Uses:
Alternative agent for surgical prophylaxis in patients who have a beta-lactam allergy and are undergoing:
-Cardiac procedures (e.g., coronary artery bypass, cardiac device insertion, ventricular assist devices)
-Neurosurgery (e.g., elective craniotomy and cerebrospinal fluid-shunting procedures, implantation of intrathecal pumps)
-Thoracic procedures (e.g., lobectomy, pneumonectomy, lung resection, thoracotomy, or video-assisted thorascopic surgery)
-Some orthopedic procedures (e.g., spinal procedures without instrumentation, hip fracture repair)
-Some urologic procedures (e.g., clean surgery without entry into urinary tract)
-Heart, lung, and heart-lung transplantation procedures (e.g., heart transplantation, lung and heart-lung transplantation)
-Clean-contaminated or clean plastic surgery procedures with risk factors

Alternative agent (in combination with an aminoglycoside, aztreonam, or fluoroquinolone) for surgical prophylaxis in patients who have a beta-lactam allergy and are undergoing:
-Gastroduodenal procedures (e.g., procedures involving entry in to the lumen of the gastrointestinal tract or procedures not entering the GI tract in high-risk patients)
-Some urologic procedures (e.g., clean surgery involving implanted prosthesis)

Usual Pediatric Dose for Meningitis:

IDSA, AAN, AANS, and NCS Recommendations:
60 mg/kg IV per day, given in divided doses every 6 hours
-Duration of therapy: 2 weeks

Use: Treatment of patients with healthcare-associated ventriculitis and meningitis

Usual Pediatric Dose for CNS Infection:

IDSA, AAN, AANS, and NCS Recommendations:
60 mg/kg IV per day, given in divided doses every 6 hours
-Duration of therapy: 2 weeks

Use: Treatment of patients with healthcare-associated ventriculitis and meningitis

Usual Pediatric Dose for Shunt Infection:

IDSA, AAN, AANS, and NCS Recommendations:
Patients with slit ventricles: 5 mg via intraventricular route (plus gentamicin)

Patients with normal-sized ventricles: 10 mg via intraventricular route (plus gentamicin)

Patients with enlarged ventricles: 15 to 20 mg via intraventricular route (plus gentamicin)

Frequency of dosing:
-External drain output less than 50 mL/day: every 3 days
-External drain output 50 to 100 mL/day: every 2 days
-External drain output 100 to 150 mL/day: once a day
-External drain output 150 to 200 mL/day: increase the dose by 5 mg (plus gentamicin) and give once a day
-External drain output 200 to 250 mL/day: increase the dose by 10 mg (plus gentamicin) and give once a day

Comments:
-Some experts recommend decreasing the dose by 60% when treating infants to account for lower cerebrospinal fluid volume (compared to adults).

Use: Treatment of healthcare-associated ventriculitis and meningitis in patients who respond poorly to systemic antibiotics

Usual Pediatric Dose for Head Injury:

AFIDS, SIS, and IDSA Recommendations:
60 mg/kg, divided and given every 6 to 8 hours
-Duration of therapy: 5 days OR until cerebrospinal fluid leak is closed, whichever is longer

Use: Antimicrobial prophylaxis for patients with penicillin allergies who have a penetrating brain or spinal cord injury

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.

Date modified: June 01, 2017
Last reviewed: March 27, 2014

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