VANCOMYCIN

Glycopeptides, antibacterial agent with bactericidal activity against aerobic and anaerobic Gram-positive bacteria including methicillin-resistant Staphylococcus aureus (MRSA)

Dosage Forms

Powder for solution for infusion

500 mg

Uses

  • Endocarditis
  • Osteomyelitis
  • Pneumonia
  • Soft-tissue infections
  • Antibiotic associated colitis
  • Surgical prophylaxis

Dose and Duration

Antibiotic associated colitis

By mouth

Adult and child over 12 years: 125–500 mg every 6 hours for 7–10 days.

Child 5–12 years: 62.5 mg every 6 hours and 250 mg every 6 hours in life threatening infections for 7–10 days.

Child 1 month–5 years: 5 mg/kg every 6 hours and 10 mg/kg in life-threatening infections for 7–10 days.

Surgical prophylaxis

Adult: by slow IV infusion over at least 60 minutes, 1 g.

Other uses

By slow IV infusion over at least 60 minutes. May be given for up to 4–6 weeks depending on condition.

Adult and child above 12 years: 500 mg every six hours or 1 g every 12 hours.

Elderly > 65 years: 500 mg every 12 hours or 1 g once daily.

Neonate over 35 weeks postmenstrual age and child 1 month–12 years: 15 mg/kg every 8 hours.

Neonate 29–35 weeks postmenstrual age: 15 mg/kg every 12 hours, adjusted basing on plasma concentration.

Neonate less than 29 weeks postmenstrual age: 15 mg/kg every 24 hours, adjusted according to plasma concentration.

Preparation

  • Consult product literature. Injection can be used to prepare solution for oral administration

Contraindications

  • Hypersensitivity to vancomycin

Side Effects

  • Decrease in blood pressure
  • Thrombophlebitis
  • Dyspnoea, stridor (high-pitched breath sound)
  • Exanthema and mucosal inflammation
  • Pruritus, urticaria
  • Increased serum creatinine
  • Redness of upper body and face
  • Pain and spasm of the neck and back muscles

Interactions

  • Ciclosporin (increased risk of nephrotoxicity)
  • Suxamethonium (enhanced effects of suxamethonium)
  • Gentamicin (increased risk of nephrotoxicity and ototoxicity)
  • Furosemide (increased risk of ototoxicity)

Pregnancy

  • Can be used.

Breastfeeding

  • Can be used.

⚠️ Caution

  • Vancomycin should not be given by mouth for systemic infections because it is not absorbed significantly.
  • Avoid rapid infusions due to increased risk of anaphylactoid reactions.
  • Rotate infusion sites.
  • Avoid in patients with a history of deafness.
  • Monitor auditory function in elderly or in patients with renal impairment.
  • Reduce dose in renal impairment and monitor renal function regularly.
  • Measure plasma concentration of vancomycin after 3 or 4 doses in patients with normal renal function or earlier in renal impairment.
  • Only use in pregnancy if clearly needed and after careful risk/benefit evaluation.
  • If used in a breast feeding mother, consider temporarily discontinuing breast feeding.