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Vancomycin

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Vancomycin, Telavancin, Vibativ, Dalbavancin, Dalvance, Oritavancin, Orbactiv

  • 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
  • Preparations
  1. Standard agents
    1. Vancomycin
    2. Telavancin (Vibativ)
  2. Longer acting agents (released around 2014)
    1. Dalbavancin (Dalvance)
      1. Infused over 30 minutes weekly
    2. 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
  • 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
  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
  • Pharmacokinetics
  • Goal Levels
  1. Peak: 20-50 ug/ml
  2. Trough: 5-10 ug/ml
  • 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
  • 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)
  • References
  1. Lacy (2000) Drug Information Handbook, Lexi-Comp