Trade Names:Vancomycin- Injection, lyophilized powder for solution 500 mg- Injection, lyophilized powder for solution 750 mg- Injection, lyophilized powder for solution 1 g- Injection, lyophilized powder for solution 5 g- Injection, lyophilized powder for solution 10 g- Injection, frozen, premixed solution 500 mg per 100 mL- Injection, frozen, premixed solution 1 g per 200 mL
Trade Names:Vancocin- Capsules 125 mg- Capsules 250 mg
Inhibits bacterial cell wall synthesis and alters cell-membrane permeability and RNA synthesis.
Poorly absorbed (orally). C max is 63 mcg/mL; T max is 1 h (injection).
55% protein bound. Vd is 0.3 to 0.43 L/kg. Distributes in pleural, pericardial, ascitic, and synovial fluids; in urine; in peritoneal dialysis fluid; and in atrial appendage tissue.
No apparent metabolism of the drug.
Mean half-life is 4 to 6 h. 75% is excreted in urine by glomerular filtration (in the first 24 h). Mean plasma Cl is 0.058 L/kg/h. Renal Cl is 0.048 L/kg/h.
Renal impairment slows excretion of vancomycin; in anephric patients, half-life is 7.5 days. Dosage adjustment required.Elderly
Total systemic and renal Cl may be reduced.
Treatment of serious or severe infections caused by susceptible strains of methicillin-resistant (beta-lactam–resistant) staphylococci; treatment of endocarditis caused by staphylococci, streptococcus, and diphtheroid.Oral
Treatment of pseudomembranous colitis caused by Clostridium difficile ; treatment of staphylococcal enterocolitis.
Aerosolization; central venous catheter infection; preoperative prophylaxis; rectal administration; ventricular shunt infections.
IV 500 mg every 6 h or 1 g every 12 h at a rate no faster than 10 mg/min or over at least 60 min, whichever is longer.Children
IV 10 mg/kg per dose given every 6 h over at least 60 min.Neonates (1 mo of age or younger)
IV An initial dose of 15 mg/kg is suggested, followed by 10 mg/kg every 12 h for neonates in the first week of life and every 8 h thereafter up to 1 mo of age.OralPseudomembranous Colitis/Staphylococcal Enterocolitis Adults
PO 500 mg to 2 g in 3 or 4 divided doses for 7 to 10 days.Children
PO 40 mg/kg/day in 3 or 4 divided doses for 7 to 10 days; max dosage is 2 g/day.Off-Label DosingAerosolization Adults
120 mg (1 mL) every 6 h via face mask.Children
250 mg per 4 mL per 10 min every 12 h, 40 mg 3 times a day for 72 h, 4 mg/kg per dose 4 times a day for 5 days.Alternative Dosing Adults
IV Daily doses of 15 to 20 mg/kg (as actual body weight) every 8 to 12 h when the minimum inhibitory concentration is 1 mg/L or less; in complicated infections, loading dose of 25 to 30 mg/kg (based on actual body weight) to rapidly achieve target trough serum concentrations.Central Venous Catheter Infection Children
Add 25 mg/mL to the parenteral nutrition solution and administer as a continuous infusion or as a flush/lock.Hospital-Acquired Pneumonia Adults
IV 15 mg/kg every 12 h.Preoperative Antimicrobial Prophylaxis
For cardiac surgery (prosthetic valve or pacemaker), neurosurgery (craniotomy), and orthopedic surgery (internal fixation of fractures or prosthetic joints), the preoperative dose in children is 10 mg/kg IV if the likely pathogens include methicillin-resistant Staphylococcus aureus or methicillin-resistant Staphylococcus epidermidis .
For GU and GI tract (excluding esophageal) procedures, the preoperative dose in adults is 1 g IV given over 1 to 2 h plus gentamicin 1.5 mg/kg (up to 120 mg) IV or IM. In children, the preoperative dose is 20 mg/kg IV given over 1 to 2 h plus gentamicin 1.5 mg/kg IV or IM. Complete the infusion/injection within 30 min of starting the procedure. This regimen is indicated for high-risk patients who are allergic to ampicillin or amoxicillin. For moderate-risk patients who are allergic to ampicillin or amoxicillin, the regimen excludes gentamicin.Rectal Administration Adults
Initial doses of 1 to 2 g and maintenance dosing of 100 to 500 mg every 6 h. Administration is recommended as an enema or with a Bardex catheter (as with a barium enema).Ventricular Shunt Infection Children
IV Systemic vancomycin is generally given at a dosage of 15 mg/kg every 6 h. Also administer 10 mg/day (50 mg/mL diluted with normal saline to a final concentration of 5 mg/mL) directly into the ventricle (if the shunt is not externalized) or into the externalized shunt, which is then clamped for 1 h after administration.Other Infections in Children Severe Infections, Including CNS Infections (Meningitis)
IV 10 to 15 mg/kg every 6 h. For meningitis, the dosage is 15 mg/kg every 6 h; max, 1 g per dose or 4 g/day.Mild to Moderate Infections
IV 40 mg/kg/day in divided doses every 6 to 8 h; max, 1 g per dose or 2 g/day.Neonates
IV Base optimal dosage on serum concentrations, especially in neonates with low birth weight (less than 1.5 kg). For neonates with very low birth weight (less than 1.2 kg), dosing every 18 to 24 h may be appropriate for the first 7 days of life.0 to 4 wk of age and weighing less than 1.2 kg
15 mg/kg IV every 24 h.Younger than 1 wk of age
Adjust dosage in elderly patients.Renal Function Impairment Adults
Adjust dosage based on CrCl and vancomycin levels.
IV 1 g every 4 to 7 daysAnephric patients Adults
IV Initial dose of 15 mg/kg followed by 1.9 mg/kg every 24 h or 250 to 1,000 mg every 7 to 10 days.Anuria Adults
IV 1,000 mg every 7 to 10 days.
Store at 68° to 77°F. After reconstitution, vials may be stored in a refrigerator for 14 days. Solutions diluted with dextrose 5% or sodium chloride 0.9% may be stored in a refrigerator for 14 days; solutions diluted with Ringer's lactate, dextrose 5%/sodium chloride 0.9%, Ringer's lactate/dextrose 5%, or Normosol-M and dextrose 5% may be stored in a refrigerator for 96 h.Oral
Store at 59° to 86°F.
May increase risk of nephrotoxicity and/or neurotoxicity.Anesthetics
Increased risk of hypersensitivity and infusion-related reactions. Give vancomycin as a 60-min infusion prior to anesthetic inductionIndomethacin
May increase vancomycin toxicity in neonates.Methotrexate
May increase methotrexate toxicity.Nondepolarizing muscle relaxants
Neuromuscular blockade may be enhanced.
None well documented.
Exfoliative dermatitis, inflammation at site of injection, pruritus, rash, Stevens-Johnson syndrome, TEN, urticaria, vasculitis; drug rash with eosinophilia and systemic symptoms (postmarketing)
Antibiotic-associated colitis, nausea.
Increased serum creatinine and BUN; interstitial nephritis, renal failure (rare).
Eosinophilia, reversible agranulocytosis, reversible neutropenia; thrombocytopenia (rare).
Anaphylaxis, chills, drug fever, hypotension, red man syndrome (flushing of the face, neck, upper chest, and extremities).
Perform serial monitoring of renal function. Monitor auditory function. Monitor leukocyte count in patients who are on prolonged therapy or who are receiving concomitant drugs that may cause neutropenia. Monitor vancomycin trough concentrations prior to next dose at steady-state concentrations (approximately after the fourth dose) and maintain above 10 mg/L. Ensure that minimum trough concentrations are higher (at least 15 to 20 mg/L) in patients with complicated infections.
Category C (injection); Category B (oral).
Excreted in breast milk.
Confirming serum levels is recommended.
Adjust dosage schedules.
Anaphylactoid reactions may occur.
Dosage adjustments required; use with caution.
Use with caution in patients with preexisting hearing loss, patients receiving ototoxic or nephrotoxic drugs, and patients receiving drugs that cause neutropenia, nephrotoxicity, and/or neurotoxicity.
Give by secure IV route. May minimize thrombophlebitis by giving slowly as dilute infusion. Chemical peritonitis has been reported following intraperitoneal administration.
Too rapid IV infusion or bolus administration may be associated with exaggerated hypotension, including shock and cardiac arrest, with or without maculopapular rash over face, neck, upper chest, and extremities (red man or red neck syndrome). Reaction has been rarely associated with slow infusion or oral or intraperitoneal administration.
May occur after total dose of 25 g.
Hearing loss, increased BUN, increased serum creatinine, ringing in ears, vertigo.
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