II. Indications

  1. First Line Agent
    1. Methicillin-resistant Staphylococcus aureus
    2. Staphylococcus epidermidis (non-contaminant)
    3. Bacillus cereus
    4. Corynebacterium jeikeium
    5. Chryseobacterium
  2. Second Line Agent
    1. Clostridium difficile
    2. Enterococcus faecalis
    3. Methicillin-susceptible Staphylococcus aureus

III. Preparations

  1. Standard agents
    1. Vancomycin
    2. Telavancin (Vibativ)
  2. Longer acting agents (released around 2014)
    1. See Lipoglycopeptide Antibiotics
    2. Dalbavancin (Dalvance)
      1. Infused over 30 minutes weekly
    3. Oritavancin (Orbactiv)
      1. Infused over 3 hours
      2. Single dose may be sufficient for MRSA Cellulitis
  3. References
    1. (2014) Presc Lett 21(8): 43

IV. Dosing: Parenteral Vancomycin

  1. Child
    1. Dose: 10 mg/kg/dose IV (over 1-2 hours) q6 hours
  2. Adult
    1. Dose: 15-20 mg/kg IV every 12 hours
    2. Precaution: 1 gram IV (over 1-2 hours) every 12 hours is only the dose for a 70 kg patient (but will be inadequate for a heavier patient)
    3. Consider dosing in 250 mg increments

V. Dosing: Oral Vancomycin for Clostridium difficile

  1. Second-line agent in Pseudomembranous colitis
  2. Adult Dose: 125 mg PO qid for 10 days
  3. Child Dose: 40 mg/kg/day PO divided qid
  4. Newborn Dose: 10 mg/kg/day PO divided qid

VI. Pharmacokinetics: Goal Levels

  1. Peak: 20-50 ug/ml
  2. Trough: 5-10 ug/ml

VII. Precautions

  1. Infuse slowly over 1-2 hours
  2. Indications to Monitor levels
    1. High dose Vancomycin (>2 grams per day)
    2. Renal Insufficiency or Renal Failure
  3. Vancomycin is a large molecule that crosses the blood-brain barrier

VIII. Adverse Effects

  1. Excessive Histamine release (rapid infusion)
    1. Angioedema
    2. Flushed skin
    3. Hypotension
  2. Toxicity if co-administered with Aminoglycoside
    1. Ototoxicity
    2. Nephrotoxicity
  3. Neutropenia
  4. Rash
  5. IgA Bullous Dermatosis (rare)

IX. References

  1. Lacy (2000) Drug Information Handbook, Lexi-Comp

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Related Studies

Cost: Medications

vancomycin (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
VANCOMYCIN 1 GM VIAL Generic $13.24 each
VANCOMYCIN 500 MG VIAL Generic $6.50 each
VANCOMYCIN HCL 125 MG CAPSULE Generic $7.05 each
VANCOMYCIN HCL 250 MG CAPSULE Generic $10.32 each
VANCOMYCIN HCL 5 GM VIAL Generic $29.51 each

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
Polish Wankomycyna
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