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.