Absorption: Poorly absorbed from the GI tract.
Distribution: Widely distributed. Some penetration (20–30%) of CSF; crosses placenta.
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).
CV: hypotension.
Derm: ACUTE GENERALIZED EXANTHEMATOUS PUSTULOSIS, DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS, LINEAR IGA BULLOUS DERMATOSIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, rash.
EENT: ototoxicity.
GI: nausea, vomiting.
GU: nephrotoxicity.
Hemat: eosinophilia, leukopenia.
Local: phlebitis.
MS: back and neck pain.
Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS), chills, fever, "red man" syndrome (with rapid infusion).
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): <1200 g: 15 mg/kg every 24 hr. 1200–2000 g: 10–15 mg/kg every 8–12 hr. >2000 g: 15–20 mg/kg every 8 hr.
- IV (Neonates <1 wk): <1200 g: 15 mg/kg every 24 hr. 1200–2000 g: 10–15 mg/kg every 12–18 hr. >2000 g: 10–15 mg/kg every 8–12 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).
Renal Impairment
- IV (Adults): An initial loading dose of 750 mg–1 g (not less than 15 mg/kg); serum level monitoring is optimal for choosing maintenance dose in patients with renal impairment; these guidelines may be helpful. CCr 50–80 mL/min — 1 g every 1–3 days; CCr 10–50 mL/min — 1 g every 3–7 days; CCr <10 mL/min — 1 g every 7–14 days.
Therapeutic Classification: anti-infectives
80 mL/min)