II. Indications
III. Mechanism
IV. Dosing: IV Vancomycin
- Child
- Infuse each dose over 1 to 2 hours
- Load: 15 mg/kg IV for first dose
- Next: 10 mg/kg/dose IV every 6 hours
- Dose every 8 hours if age 1 week to 1 month
- Dose every 12 hours if age <1 week old
- Adult
- Dose: 15 to 20 mg/kg IV every 8 to 12 hours
- Consider loading first dose at 25 to 30 mg/kg IV in severe infections
- Adjust dosing intervals in reduced Renal Function
- General
- Infuse dose over 1 hour (over 1.5 to 2 hours if dose >1 gram)
- Monitor drug levels or limit to maximum dose of 2 g/day
- Consider dosing in 250 mg increments
- Standard 1 gram IV (over 1-2 hours) every 12 hours is only the dose for a 70 kg patient
- Dose is based on absolute body weight (adjust with trough levels in obese patients)
- This standard dose will be inadequate for a heavier patient
- Dose: 15 to 20 mg/kg IV every 8 to 12 hours
V. Dosing: Oral Vancomycin (Firvanq) for Clostridium difficile
- Second-line agent in Clostridium difficile (Pseudomembranous colitis)
- Adult Dose
- Take 125 mg orally divided four times daily
- Child Dose
- Give 40 mg/kg/day orally divided four times daily
- Newborn Dose
- Give 10 mg/kg/day orally divided four times daily
VI. Adverse Effects
- See Glycopeptide Antibiotic
-
Red Man Syndrome
- Infuse slowly
- Consider premedication with Antihistamines
- Phlebitis
- With extravasation
- End organ toxicity
- Neutropenia (reversible)
- Ototoxicity
- Nephrotoxicity
- Increased risk of Acute Kidney Injury when combined with Piperacillin-tazobactam
- Monitor Renal Function
VII. Safety
- Safe in Pregnancy
- Safe in Lactation
VIII. Pharmacokinetics: Goal Levels
- Peak Levels: 20-50 mg/L (not recommended for drug monitoring)
- Monitor with trough levels drawn immediately before next dose (after fourth dose)
- Target Trough level: >10 mg/L (15 to 20 mg/L in complicated infections)
IX. Precautions
- Infuse slowly over 1-2 hours
- Indications to Monitor levels
- High dose Vancomycin (>2 grams per day)
- Renal Insufficiency or Renal Failure
- Vancomycin is a large molecule that crosses the blood-brain barrier
X. Resources
XI. References
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- Lacy (2000) Drug Information Handbook, Lexi-Comp
- (2014) Presc Lett 21(8): 43
Images: Related links to external sites (from Bing)
Related Studies
| vancomycin (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| VANCOMYCIN HCL 125 MG CAPSULE | Generic | $1.40 each |
| VANCOMYCIN HCL 250 MG CAPSULE | Generic | $1.98 each |
| firvanq (on 10/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| FIRVANQ 50 MG/ML SOLUTION | $0.94 per ml | |
Ontology: Vancomycin (C0042313)
| Definition (CHV) | a kind of antibacterial drug |
| Definition (NCI) | A branched tricyclic glycosylated peptide with bactericidal activity against most organisms and bacteriostatic effect on enterococci. At a site different from that of penicillins and cephalosporins, vancomycin binds tightly to the D-alanyl-D-alanine portion of cell wall precursors, thereby interfering with bacterial cell wall synthesis. This leads to activation of bacterial autolysins that destroy the cell wall by lysis. Vancomycin may also alter the permeability of bacterial cytoplasmic membranes and may selectively inhibit RNA synthesis. |
| Definition (NCI_NCI-GLOSS) | An antibiotic drug used to fight resistant bacterial infections. |
| Definition (MSH) | Antibacterial obtained from Streptomyces orientalis. It is a glycopeptide related to RISTOCETIN that inhibits bacterial cell wall assembly and is toxic to kidneys and the inner ear. |
| Definition (CSP) | antibacterial obtained from Streptomyces orientalis; a glycopeptide that inhibits bacterial cell wall assembly and is toxic to kidneys and the inner ear. |
| Concepts | Antibiotic (T195) , Amino Acid, Peptide, or Protein (T116) |
| MSH | D014640 |
| SnomedCT | 372735009, 42082003 |
| LNC | LP16306-0, MTHU004271 |
| English | Vancomycin, vancomycin (medication), Vancomycin [Chemical/Ingredient], vancomycin, VANCOMYCIN, Vancomycin (product), Vancomycin (substance), VANCO |
| Swedish | Vankomycin |
| Czech | vankomycin |
| Finnish | Vankomysiini |
| Russian | VANKOMITSIN, ВАНКОМИЦИН |
| Polish | Wankomycyna |
| Croatian | VANKOMICIN |
| Japanese | バンコマイシン, バンコシン |
| Spanish | vancomicina (producto), vancomicina (sustancia), vancomicina, Vancomicina |
| French | Vancomycine |
| German | Vancomycin |
| Italian | Vancomicina |
| Portuguese | Vancomicina |
