Classes
DEA Class; Rx
Common Brand Names; Vancocin, Firvanq
- Glycopeptides
Description
Glycopeptide antibiotic; only effective for gram-positive bacteria; poorly absorbed orally; however, used orally to treat GI infections such as pseudomembranous colitis; serum concentration monitoring with systemic use.
Indications
Indicated for enterocolitis caused by Staphylococcus aureus (including methicillin-resistant strains)
Indicated for treatment of Clostridium difficile (C. difficile)-associated diarrhea
Indicated for treatment of infective endocarditis due to: susceptible isolates of MRSA, viridans group streptococci Streptococcus gallolyticus, Enterococcus species, and Corynebacterium species
For enterococcal endocarditis, use in combination with an aminoglycoside
Methicillin-susceptible staphylococci in penicillin-allergic patients, or those patients who cannot receive or who have failed to respond to other therapies
Indicated for treatment of early-onset prosthetic valve endocarditis caused by Staphylococcus epidermidis in combination with rifampin and an aminoglycoside
Indicated for treatment of septicemia due to: susceptible isolates of methicillin-resistant Staphylococcus aureus (MRSA) and coagulase negative staphylococci, methicillin-susceptible staphylococci in penicillin-allergic patients, or patients who cannot receive or who have failed to respond to other drugs, including penicillins or cephalosporins
Indicated for treatment of skin and skin structure infections due to: susceptible isolates of MRSA and coagulase negative staphylococci, methicillin-susceptible staphylococci in penicillin-allergic patients, or those patients who cannot receive or have failed to respond to other therapies
Indicated for treatment of bone infections due to: susceptible isolates of MRSA and coagulase negative staphylococci, methicillin-susceptible staphylococci in penicillin-allergic patients, or those patients who cannot receive or have failed to respond to other therapies
Indicated for treatment of lower respiratory tract infections due to: susceptible isolates of MRSA and coagulase negative staphylococci, methicillin-susceptible staphylococci in penicillin-allergic patients, or those patients who cannot receive or have failed to respond to other therapies
Prophylaxis of infection in cardiac, thoracic, and arterial procedures; craniotomy; joint replacement; amputation
Contraindications
Hypersensitivity
Adverse Effects
- Nausea (17%)
- Abdominal pain (15%)
- Hypokalemia (13%)
- Vomiting (9%)
- Diarrhea (9%)
- Pyrexia (9%)
- Flatulence (8%)
- Urinary tract infection (8%)
- Headache (7%)
- Peripheral edema (6%)
- Back pain (6%)
- Fatigue (5%)
- Nephrotoxicity (5%)
Warnings
Rapid IV administration may result in flushing, pruritus, hypotension, erythema, and urticaria
Systemic vancomycin exposure may result in acute kidney injury (AKI) and interstitial nephritis; risk of AKI increases as systemic exposure increases; additional risk factors for AKI include concomitant use of nephrotoxic drugs, patients with pre-existing renal impairment, or with comorbidities that predispose to renal impairment
Endocarditis prophylaxis: Use only for high-risk patients, per AHA guidelines
Ototoxicity may occur; toxicity proportional to amount of drug given and duration of treatment; presence of tinnitus or vertigo may indicate vestibular injury; discontinue 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
Hemorrhagic occlusive retinal vasculitis, including permanent loss of vision, occurred in patients receiving intracameral or intravitreal administration of vancomycin during or after cataract surgery; safety and efficacy of vancomycin administered by intracameral or intravitreal route not established by adequate and well-controlled trials; vancomycin not indicated for prophylaxis of endophthalmitis
Oral vancomycin only indicated for treatment of pseudomembranous colitis due to Clostridioides difficile (C. difficile) and enterocolitis due to S. aureus; not effective for systemic infections
Pregnancy and Lactation
Unknown whether vancomycin can affect reproduction capacity
In a controlled clinical study, potential ototoxic and nephrotoxic effects of vancomycin on infants were evaluated when administered to pregnant women for serious staphylococcal infections complicating IV drug abuse
Vancomycin is excreted in human milk
Maximum Dosage
2 g/day IV/PO per FDA-approved labeling; individualize IV dosage to patient age, weight, indication for use, and serum drug concentration monitoring.
2 g/day IV/PO per FDA-approved labeling; individualize IV dosage to patient age, weight, indication for use, and serum drug concentration monitoring.
40 mg/kg/day IV and 2 g/day PO per FDA-approved product labeling; however, initial doses up to 60 mg/kg/day IV are recommended off-label for severe infections. Individualize IV dosage to patient age, weight, indication for use, and serum drug concentration monitoring.
40 mg/kg/day IV and 2 g/day PO per FDA-approved product labeling; however, initial doses up to 60 mg/kg/day IV are recommended off-label for severe infections. Individualize IV dosage to patient age, weight, indication for use, and serum drug concentration monitoring.
40 mg/kg/day IV/PO per FDA-approved product labeling; however, initial doses up to 60 mg/kg/day IV are recommended off-label for severe infections. Individualize IV dosage to patient age, weight, indication for use, and serum drug concentration monitoring.
8 days and older: 30 mg/kg/day IV per FDA-approved product labeling; however, doses should be individualized based on patient age, weight, indication for use, and serum drug concentration monitoring.
0 to 7 days: 20 mg/kg/day IV per FDA-approved product labeling; however, doses should be individualized based on patient age, weight, indication for use, and serum drug concentration monitoring.
How supplied
vancomycin hydrochloride
capsule (Vancocin)
- 125mg
- 250mg
injection, lyophilized powder for reconstitution (generic)
- 500mg
- 750mg
- 1g
- 5g
- 10g
kit, powder for oral solution (Firvanq)
- 3.75g
- 7.5g
- 10.5g
- 15g
injection, single-dose flexible bag (generic)
- 500mg/100mL
- 750mg/150mL
- 1g/200mL
- 1.25g/250mL
- 1.5g/300mL
- 1.75g/350mL
- 2g/400mL
