Vancomycin

Vancomycin

  • Vancomycin is a tricyclic glycopeptide that is effective against multiple drug resistant organisms, such as MRSA & enterococci
  • Vancomycin inhibits synthesis of bacterial cell wall phospholipids
  • Covers MRSA
  • Covers Gram +, Aerobic
  • Cleared by kidneys
  • Works slow (very slow onset antibiotic)
  • Dosage is based on ideal body weight (15mg/kg actual body weight)
  • Therapeutic Trough Range 15-20 for serious infections; 10-15 for less severe infections
  • Does not enter CSF, unless inflamed

Used in the treatment of MRSA & Pseudomembranous Colitis caused by C.Difficile , but must be given orally to treat C. Difficile
Side Effects

  • Nephrotoxicity, Ototoxicity, Red Man Syndrome, neutropenia, anaphylaxis
  • Red Man Syndrome is a widespread reddening of the skin, because of this, it must be given slowly over the 1st hour.

CDC Recommendations for Vancomycin

Adult Dosing – Severe Bacterial Infections 

  • Dosage forms: 125, 250, IV
  • 15-20 mg/kg IV q8-12h
  • Consider start 25-30 mg/kg IV x1 in seriously ill pts
  • Use ABW to calculate dose adjust dose based on serum levels; consider lower total daily dose if
  • BMI >40 kg/m^2
  • Adjust dose based on serum levels consider lower total daily dose if BMI >40 kg/m^2
    consider lower total daily dose if BMI >40 kg/m^2

Adult Dose – C. Difficile Infection

  • 1st episode
  • Dose: 125 mg PO Q 6 HR x10-14 days

1st episode/1st recurrence – severe complicated

  • 500 mg PO Q 6 HR – may use with metronidazole IV
  • Add vancomycin 500 mg in 100 mL NS retention enema PR Q 6 HR if complete ileus

2nd recurrence

  • 125 mg PO Q 6 HR x10-14 days, then 125 mg PO Q 12 HR x7 days, then 125 mg PO QD X 7 days, then 125 mg PO Q 2-3 days x 2-8 weeks

Adult Dose – Enterocolitis, Staphylococcal

  • 500-2000 mg day PO divided Q 6-8 HR x 7-10 days
  • May mix IV powder in 30 mL water and give PO
  • CrCl 50-90: 15 mg/kg x1, then usual dose q12-24 HR; CrCl 10-50: 15 mg/kg x1, then usual dose Q 24-96 HR; CrCl <10: 15 mg/kg x1, then usual dose Q 4-7 days

 

Pediatric Dosing – Severe Bacterial Infections

  • Dosage forms: 125,250; IV
  • 1 months -11 years
  • 10-15 mg/kg IV Q 6-8 HR; Max: 1 g/dose; Info: adjust dose based on serum levels
  • 12-16 years old
  • 1000 mg IV q12h; Alt: 10-15 mg/kg IV q12h; Info: adjust dose based on serum levels; patients with high clearance may require 1200-1500 mg IV Q12 HR or 10 mg/kg IV Q 8 HR

Pediatric Dosing – C. Difficile Infection

  • 40 mg/kg/day PO divided Q 6-8 HR x7-10 days
  • Max: 500 mg/dose, 2000 mg/day
  • For severe infection or 2nd recurrence: may mix IV powder in 30 mL water and give PO; may use in combo w/ metronidazole PO

 

Pediatric Dosing – enterocolitis, staphylococcal

  • 40 mg/kg/day PO divided Q 6-8h x 7-10 days
  • Max: 500 mg/dose, 2000 mg/day; Info: may mix IV powder in 30 mL water and give PO

Pediatric Dosing- Community-Acquired Pneumonia, Severe Bacterial

  • >3 months
  • 40-60 mg/kg/day IV divided Q 6-8 HRx10-14 days
  • May switch to appropriate oral regimen when possible to complete course

Key Notes

Vancomycin IV is used for serious/ life-threatening staphylococcal or streptococcal infections.

Vancomycin is the drug of choice for severe cases of C. difficile

 

***This is a study guide only & not intended for drug dosing. Please refer to CDC guidelines.

 

References

 

Edmunds, M. W., & Mayhew, M. S. (2014). Pharmacology for the primary care provider (4th ed.). St. Louis, MO: Elsevier Mosby.

Harvey, R. A., Clark, M. A., Finkel, R., Rey, J. A., & Whalen, K. (2012). Pharmacology (5th ed.). Baltimore, MD: Lippincott.