VANCOMYCIN

Indications & Dose:

Serious or severe Gram-positive infections not treatable with other antimicrobials, including penicillins and cephalosporins, caused by susceptible organisms (e.g., endocarditis, osteomyelitis, pneumonia, and pseudomembranous colitis)

DOSE

Note: Administer IV doses over 60 min; prevents “red-neck syndrome”

By mouth, antibiotic associated colitis; 125mg every 6 hour for 7-10 days CHILD:5mg/kg every 6 hours, over 5 years half of the adult doser.

Adult

• Serious staphylococcal infections: IV 500 mg q6h or 1 g q 12h by slow i.v or infusion over 60 minutes

• Pseudomembranous, staphylococcal enterocolitis: PO 500 mg to 2 g/day in 3-4 divided doses for 7-10 days

• Dosage adjustment for renal impairment: After initial loading dose of 750 mg to 1g, CrCl 50-80 ml/ min 1 g q 1-3d, CrCl 10-50 ml/min 1 g q3-7d, CiCl < 10 1 g q7-14d; guided by serum vancomycin concentrations

Children

Usually 10mg/kg every 6 hours by slow i.v or infused over 60 minutes

• Serious staphylococcal infections: IV 40 mg/kg/ day divided qbh

Infants & neonates: Initially 15mg/kg followed by 10mg/kg 12 hourly in 1st week of life and then 8 hourly upto 1 month age.

Neonates

• Serious staphylococcal infections: IV 15 mg/kg initially followed by 10 mg/kg q8-12h

• Pseudomembranous, staphylococcal enterocolins: PO 40 mg/kg/day divided q6h, not to exceed 2 g/day.

Contraindications:

Decreased hearing 

Side Effects:

Cautions:

Precautions:

Renal disease, elderly, neonates 

Interaction:

Drugs

Aminoglycosides: Enhanced nephrotoxicity

Indomethacin : Increased vancomycin in neonates, possible vancomycin toxicity

Methotrexate: Reduced methotrexate concentrations with oral vancomycin

Warnings:

Adverse Effects:

Lactations:

Excreted into breast milk, milk level 4 hr after steady state dose, 12.7 ug/ml (similar to mother’s trough level); poorly absorbed orally, systemic absorption not expected; problems limited to modification of bowel flora, allergic sensitization, and interference with interpretation of culture results during fever workup 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CV: Cardiac arrest, vascular collapse

EENT: Ototoxicity, permanent deafness, tinnitus

HEME: Eosinophilia, leukopenia, neutropenia

GI: Nausea

GU: Nephrotoxicity

RESP: Dyspnea, wheezing

SKIN: Chills, fever, necrosis with extravasation (red man’s syndrome or “red-neck syndrome”), pruritus, rash, thrombophlebitis at inj site, urticaria 

Patient And Carer Advice: