• IV: Potentially life-threatening infections when less toxic anti-infectives are contraindicated. Particularly useful in staphylococcal infections, including:
  • endocarditis,
  • meningitis,
  • osteomyelitis,
  • pneumonia,
  • septicemia,
  • soft-tissue infections in patients who have allergies to penicillin or its derivatives or when sensitivity testing demonstrates resistance to methicillin.
• PO: Staphylococcal enterocolitis or diarrhea due to Clostridioides difficile.
• IV: Part of endocarditis prophylaxis in high-risk patients who are allergic to penicillin.

Contraindicated in:

• Hypersensitivity.

Use Cautiously in:

• Renal impairment (dose ↓ required if CCr ≤80 mL/min)
• Hearing impairment
• Intestinal obstruction or inflammation (↑ systemic absorption when given orally)
• OB: Pharmacokinetics of IV vancomycin may be altered in pregnancy (volume of distribution may be ↑); systemic absorption of PO vancomycin expected to be minimal
• Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant.

CV: hypotension.

Derm: ACUTE GENERALIZED EXANTHEMATOUS PUSTULOSIS, DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS, LINEAR IGA BULLOUS DERMATOSIS, rash, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS.

EENT: ototoxicity.

GI: nausea, vomiting.

GU: nephrotoxicity.

Hemat: eosinophilia, leukopenia.

Local: phlebitis.

MS: back and neck pain.
Misc: chills, fever, (INCLUDING ANAPHYLAXIS)HYPERSENSITIVITY REACTIONS , vancomycin flushing syndrome (with rapid infusion).

Drug-Drug:

• May cause additive ototoxicity and nephrotoxicity with other ototoxic and nephrotoxic drugs, including aspirin, aminoglycosides, cyclosporine, cisplatin, and loop diuretics.
• May enhance neuromuscular blockade from nondepolarizing neuromuscular blocking agents.
• ↑ risk of histamine flush when used with general anesthetics in children.

(Generic available)

• Capsules: 125 mg; 250 mg;
• Powder for oral solution (grape flavor): 3.75 g/bottle; 7.5 g/bottle; 15 g/bottle;
• Premixed infusion: 500 mg/100 mL D5W; 750 mg/150 mL D5W; 1000 mg/200 mL D5W or 0.9% NaCl; 1250 mg/200 mL D5W; 1500 mg/300 mL D5W; 1750 mg/350 mL D5W; 2000 mg/400 mL D5W;
• Solution for injection: 250 mg/vial; 500 mg/vial; 750 mg/vial; 1 g/vial; 1.5 g/vial; 5 g/vial; 10 g/vial; 100 g/vial;

Serious Systemic Infections

• IV (Adults): 500 mg every 6 hr or 1 g every 12 hr (up to 4 g/day).
• IV (Children >1 mo): 40 mg/kg/day divided every 6–8 hr Staphylococcal CNS infection: 60 mg/kg/day divided every 6 hr, maximum dose: 1 g/dose.
• IV (Neonates 1 wk–1 mo and >2000 g): 15–20 mg/kg every 8 hr.
• IV (Neonates 1 wk–1 mo and 1200–2000 g): 10–15 mg/kg every 8–12 hr.
• IV (Neonates 1 wk–1 mo and <1200 g): 15 mg/kg every 24 hr.
• IV (Neonates <1 wk and >2000 g): 10–15 mg/kg every 8–12 hr.
• IV (Neonates <1 wk and 1200–2000 g): 10–15 mg/kg every 12–18 hr.
• IV (Neonates <1 wk and <1200 g): 15 mg/kg every 24 hr.
• IT (Adults): 20 mg/day.
• IT (Children): 5–20 mg/day.
• IT (Neonates): 5–10 mg/day.

Endocarditis Prophylaxis in Penicillin-Allergic Patients

• IV (Adults and Adolescents): 1 g single dose 1 hr preprocedure.
• IV (Children): 20 mg/kg single dose 1 hr preprocedure.

Diarrhea Due to C. difficile

• PO (Adults): 125 mg every 6 hr for 10 days.
• PO (Children): 40 mg/kg/day divided into 3 or 4 doses for 7–10 days (not to exceed 2 g/day).

Staphylococcal Enterocolitis

• PO (Adults): 500–2000 mg/day in 3–4 divided doses for 7–10 days.
• PO (Children): 40 mg/kg/day in 3–4 divided doses for 7–10 days (not to exceed 2 g/day).

Firvanq, Vancocin

• Binds to bacterial cell wall, resulting in cell death.

• Bactericidal action against susceptible organisms.

Spectrum:

• Active against gram-positive pathogens, including:
  • Staphylococci (including methicillin-resistant strains of Staphylococcus aureus),
  • Group A beta-hemolytic streptococci,
  • Streptococcus pneumoniae,
  • Corynebacterium,
  • Clostridioides difficile,
  • Enterococcus faecalis,
  • Enterococcus faecium.

Therapeutic Classification: anti-infectives

Absorption: Poorly absorbed from the GI tract.

Distribution: Widely distributed to tissues. Some penetration (20–30%) of CSF.

Metabolism/Excretion: Oral doses excreted primarily in the feces; IV vancomycin eliminated almost entirely by the kidneys.

Half-life: Neonates: 6–10 hr; Children 3 mo–3 yr: 4 hr; Children >3 yr: 2–2.3 hr; Adults: 5–8 hr (↑ in renal impairment).

(plasma concentrations)

• Advise patients on oral vancomycin to take as directed. Take missed doses as soon as remembered unless almost time for next dose; do not double dose.
• Instruct patient to report signs of hypersensitivity, tinnitus, vertigo, or hearing loss.
• Advise patient to notify health care professional if no improvement is seen in a few days.
• Patients with a history of rheumatic heart disease or valve replacement need to be taught importance of using antimicrobial prophylaxis prior to invasive dental or medical procedures.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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