Vancomycin is indicated in potentially life-threatening infections which cannot be treated with other effective, less toxic antimicrobial drugs including the penicillins and cephalosporins. Vancomycin is useful in the therapy of severe staphylococcal infections in patients who cannot receive or who have failed to respond to the penicillins and cephalosporins or who have infections with staphylococci, resistant to other antibiotics. Vancomycin is used in the treatment of endocarditis and as prophylaxis against endocarditis in patients undergoing dental or surgical procedures. Its effectiveness has been documented in other infections due to staphylococci including osteomyelitis, pneumonia, septicemia and soft tissue infections.
Glycopeptide antibiotic; Antibacterial
Vancomycin binds tightly to D-alanyl-D-alanine portion cell wall precursor causing blockage of glycopeptide polymerisation which produces immediate inhibition of cell wall synthesis and secondary damage to the cytoplasmic membrane.
Intravenous Prophylaxis of endocarditis Adult: 1 g prior to induction of anaesth and may give another 1 g dose 12 hr after surgery. Elderly: Dosage adjustment needed. Intravenous Severe staphylococcal or other Gram-positive infections Adult: 500 mg 6 hrly, infused over at least 60 min or 1 g 12 hrly, infused over at least 100 min. Child: 0-7 days Initially, 15 mg/kg, followed by 10 mg/kg 12 hrly; 7-30 days Initially, 15 mg/kg, followed by 10 mg/kg 8 hrly; 1 mth to 12 yr 40 mg/kg daily in 4 divided doses. Admin each dose over at least 60 min. Elderly: Dosage adjustment needed. Intravenous Bacterial endocarditis Adult: 1 g 12 hrly for 4-6 wk, alone or in combination w/ other antibiotics. Elderly: Dosage adjustment needed. Oral Staphylococcal enterocolitis Adult: 0.5-2 g daily in 3-4 divided doses for 7-10 days. Child: 40 mg/kg daily, in 3 or 4 divided doses for 7-10 days. Max: 2 g daily. Elderly: Dosage adjustment needed. Oral Clostridium difficile-associated diarrhoea and colitis Adult: 125 mg 4 times daily for 7-10 days. Child: 40 mg/kg daily, in 3 or 4 divided doses for 7-10 days. Max: 2 g daily. Elderly: Dosage adjustment needed. May be taken with or without food.
Hypersensitivity. Patient w/ allergic reaction to teicoplanin, previous hearing loss, inflammatory bowel disease. Renal impairment. Elderly. Pregnancy and lactation.
Red-man syndrome (characterised by erythema, flushing or rash over the face and upper torso, and sometimes by hypotension and shock-like symptoms), hypersensitivity reactions (e.g. Stevens-Johnson syndrome, exfoliative dermatitis, toxic epidermal necrolysis, vasculitis), drug rash w/ eosinophilia and systemic symptoms (DRESS), neutropenia, eosinophilia, thrombocytopenia, agranulocytosis, ototoxicity, nephrotoxicity, thrombophlebitis, mild GI disturbances.
Supportive care is advised with maintenance of glomerular filtration. Vancomycin is poorly removed from the blood by haemodialysis or peritoneal dialysis. Haemoperfusion with Amberlite resin XAD-4 has been reported to be of limited benefit.
Store in a cool and dry place, protected from light. Keep out of reach of children.
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