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Vancomycin

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Vancomycin, Firvanq, Vancocin

  • See Also
  1. Glycopeptide Antibiotic
  • Indications
  1. See Glycopeptide Antibiotic
  • Mechanism
  1. See Glycopeptide Antibiotic
  • Dosing
  • IV Vancomycin
  1. Child
    1. Infuse each dose over 1 to 2 hours
    2. Load: 15 mg/kg IV for first dose
    3. Next: 10 mg/kg/dose IV every 6 hours
      1. Dose every 8 hours if age 1 week to 1 month
      2. Dose every 12 hours if age <1 week old
  2. Adult
    1. Dose: 15 to 20 mg/kg IV every 8 to 12 hours
      1. Consider loading first dose at 25 to 30 mg/kg IV in severe infections
      2. Adjust dosing intervals in reduced Renal Function
    2. General
      1. Infuse dose over 1 hour (over 1.5 to 2 hours if dose >1 gram)
      2. Monitor drug levels or limit to maximum dose of 2 g/day
      3. Consider dosing in 250 mg increments
      4. Standard 1 gram IV (over 1-2 hours) every 12 hours is only the dose for a 70 kg patient
        1. Dose is based on absolute body weight (adjust with trough levels in obese patients)
        2. This standard dose will be inadequate for a heavier patient
  1. Second-line agent in Clostridium difficile (Pseudomembranous colitis)
  2. Adult Dose
    1. Take 125 mg orally divided four times daily
  3. Child Dose
    1. Give 40 mg/kg/day orally divided four times daily
  4. Newborn Dose
    1. Give 10 mg/kg/day orally divided four times daily
  • Adverse Effects
  1. See Glycopeptide Antibiotic
  2. Red Man Syndrome
    1. Infuse slowly
    2. Consider premedication with Antihistamines
  3. Phlebitis
    1. With extravasation
  4. End organ toxicity
    1. Neutropenia (reversible)
    2. Ototoxicity
    3. Nephrotoxicity
      1. Increased risk of Acute Kidney Injury when combined with Piperacillin-tazobactam
      2. Monitor Renal Function
  • Safety
  1. Safe in Pregnancy
  2. Safe in Lactation
  • Pharmacokinetics
  • Goal Levels
  1. Peak Levels: 20-50 mg/L (not recommended for drug monitoring)
  2. Monitor with trough levels drawn immediately before next dose (after fourth dose)
    1. Target Trough level: >10 mg/L (15 to 20 mg/L in complicated infections)
  • Precautions
  1. Infuse slowly over 1-2 hours
  2. Indications to Monitor levels
    1. High dose Vancomycin (>2 grams per day)
    2. Renal Insufficiency or Renal Failure
  3. Vancomycin is a large molecule that crosses the blood-brain barrier
  • Resources
  1. Vancomycin (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=99e523d8-9bde-43cb-8434-497015e5dcbd
  • References
  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  2. Lacy (2000) Drug Information Handbook, Lexi-Comp
  3. (2014) Presc Lett 21(8): 43