Drug information of Vancomycin
Vancomycin is used to treat an infection of the intestines caused by Clostridium difficile, which can cause watery or bloody diarrhea. It is also used to treat staph infections that can cause inflammation of the colon and small intestines.
Oral vancomycin works only in the intestines. This medicine is not normally absorbed into the body and will not treat other types of infection. An injection form of this medication is available to treat serious infections in other parts of the body.
Mechanism of effect
Inhibits cell-wall biosynthesis; blocks glycopeptide polymerization by binding tightly to D-alanyl-D-alanine portion of cell wall precursor
It is often reserved as the "drug of last resort", used only after treatment with other antibiotics had failed. Vancomycin has been shown to be active against most strains of the following microorganisms, both in vitro and in clinical infections: Listeria monocytogenes, Streptococcus pyogenes, Streptococcus pneumoniae (including penicillin-resistant strains), Streptococcus agalactiae, Actinomyces species, and Lactobacillus species. The combination of vancomycin and an aminoglycoside acts synergistically in vitro against many strains of Staphylococcus aureus, Streptococcus bovis, enterococci, and the viridans group streptococci.
PO, poor; IM, erratic; intraperitoneal, ~38%
Peak serum time (IV): Immediately after completion of infusion
Distributed widely in body tissues and fluid, except for cerebrospinal fluid (CSF)
Relative diffusion from blood into CSF: Good only with inflammation (exceeds usual minimal inhibitory concentrations); CSF level nil with normal meninges, 20-30% of blood level with inflamed meninges
- Protein bound: ~50%
- Half-life; 5-11 hr (adults); 6-10 hr (newborns); 2-2.3 hr (children); 4 hr (infants and children 3 months to 4 years); 200-250 hr (renal impairment or end-stage renal disease)
- Excretion: Urine (IV; 80-90% as unchanged drug); primarily feces (PO)
Drug indicationsNosocomial Pneumonia , Pneumonia , Febrile Neutropenia , Skin or Soft Tissue Infection
In most Infection :
15 to 20 mg/kg IV every 8 to 12 hours (2 to 3 g/day); a loading dose of 25 to 30 mg/kg can be considered for seriously ill patients
Duration: 2 to 6 weeks, depending on the nature and severity of the infection
Pseudomembranous Colitis/Staphylococcal Enterocolitis
C. difficile: 125 mg PO q6hr for 10 days
S. enterocolitis: 0.5-2 g/day PO divided q6-8hr for 7-10 days Endocarditis
Treatment: 500 mg IV q6hr or 1 g IV q12 hr
Drug contraindicationsHypersensitivity to this drug
Side effectsnausea , dizziness , Hypokalemia , Weight increase , stomach pain
InteractionsAmikacin , Piperacillin , Gentamicin , Dimenhydrinate , Cis atracurium , Cefalotin , Alprazolam , Acetaminophen , Enoxaparin , Pregabalin , Pantoprazole , Ciprofloxacin , Furosemide , Lorazepam , Warfarin , Clopidogrel , Insulin glargine , Acetaminophen + Hydrocodone , Linezolid , Meglumine Compound , Cidofovir , Bacitracin , novafen , fenoprofen , Diatrizoate (Amidotrizoic acid) , Plazomicin , cholera vaccine live , Ioxaglate , Iothalamate Meglumine , Blonanserin , Typhoid vaccine (live), oral
• Rapid IV administration may result in flushing, pruritus, hypotension, erythema, and urticaria
• Systemic vancomycin exposure may result in acute kidney injury (AKI); the risk of AKI increases as systemic exposure/serum levels increase; additional risk factors for AKI in patients vancomycin include receipt of concomitant drugs known to be nephrotoxic, in patients with pre-existing renal impairment or with co-morbidities that predispose to renal impairment; interstitial nephritis also reported in patients receiving vancomycin
• Endocarditis prophylaxis: Use only for high-risk patients, per AHA guidelines
• Unclear whether drug is nephrotoxic or neurotoxic in regular doses, but increased nephrotoxicity and ototoxicity are associated with pre-existing renal impairment, advanced age, dehydration; also appears to potentiate nephro-/neurotoxic effects of other drugs
• Ototoxicity may occur; toxicity proportional to amount of drug given and duration of treatment; presence of tinnitus or vertigo may indicate vestibular injury; discontiue if signs of ototoxicity occur
• Risk of neutropenia increases with doses >25 g (reversible following discontinuation of therapy)
• Avoid extravasation; necrosis may occur
• Prolonged use may result in fungal or bacterial superinfection
• Use caution in patients with renal impairment; monitor trough concentrations if multiple oral doses administered
• Oral vancomycin only indicated for treatment of pseudomembranous colitis due to C. difficile and enterocolitis due to S. aureus; not effective for systemic infections
Points of recommendation
Take vancomycin exactly as prescribed by your doctor.
Taking more of this medicine will not make it more effective, and may cause serious or life-threatening side effects.
Use this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Vancomycin will not treat a viral infection such as the common cold or flu.
If you use this medication long-term, you may need frequent medical tests at your doctor's office.
Shake the oral suspension (liquid) well just before you measure a dose.
Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.
Ask a Pharmacist