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Vancomycin
Aka: Vancomycin, Telavancin, Vibativ, Dalbavancin, Dalvance, Oritavancin, Orbactiv
- Indications
- First Line Agent
- Methicillin-resistant Staphylococcus aureus
- Staphylococcus epidermidis (non-contaminant)
- Bacillus cereus
- Corynebacterium jeikeium
- Chryseobacterium
- Second Line Agent
- Clostridium difficile
- Enterococcus faecalis
- Methicillin-susceptible Staphylococcus aureus
- Preparations
- Standard agents
- Vancomycin
- Telavancin (Vibativ)
- Longer acting agents (released around 2014)
- Dalbavancin (Dalvance)
- Infused over 30 minutes weekly
- Oritavancin (Orbactiv)
- Infused over 3 hours
- Single dose may be sufficient for MRSA Cellulitis
- References
- (2014) Presc Lett 21(8): 43
- Dosing: Parenteral Vancomycin
- Child
- Dose: 10 mg/kg/dose IV (over 1-2 hours) q6 hours
- Adult
- Dose: 15-20 mg/kg IV every 12 hours
- 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)
- Consider dosing in 250 mg increments
- Dosing: Oral Vancomycin for Clostridium difficile
- Second-line agent in Pseudomembranous colitis
- Adult Dose: 125 mg PO qid for 10 days
- Child Dose: 40 mg/kg/day PO divided qid
- Newborn Dose: 10 mg/kg/day PO divided qid
- Pharmacokinetics: Goal Levels
- Peak: 20-50 ug/ml
- Trough: 5-10 ug/ml
- 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
- Adverse Effects
- Excessive Histamine release (rapid infusion)
- Angioedema
- Flushed skin
- Hypotension
- Toxicity if co-administered with Aminoglycoside
- Ototoxicity
- Nephrotoxicity
- Neutropenia
- Rash
- IgA Bullous Dermatosis (rare)
- References
- Lacy (2000) Drug Information Handbook, Lexi-Comp