Drug reference
The glycopeptide antibiotic vancomycin has bactericidal activity against aerobic and anaerobic Gram- positive bacteria including multi-resistant staphylococci. However, there are reports of Staphylococcus aureus with reduced susceptibility to glycopeptides. There are increasing reports of glycopeptide-resistant enterococci. Penetration into cerebrospinal fluid is poor.
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Clostridioides difficile infection [first episode] ▶BY MOUTH ▶Adult: 125 mg every 6 hours for 10 days; increased if necessary to 500 mg every 6 hours for 10 days, increased dose if severe or complicated infection Clostridioides difficile infection [multiple recurrences] ▶BY MOUTH ▶Adult: 125 mg every 6 hours for 10 days, followed by, either tapering the dose (gradually reducing until 125 mg daily) or a pulse regimen (125–500 mg every 2–3 days for at least 3 weeks) Moderate diabetic foot infection | Severe diabetic foot infection | Leg ulcer infection ▶BY INTRAVENOUS INFUSION ▶Adult: 15–20 mg/kg every 8–12 hours (max. per dose 2 g) adjusted according to plasma-concentration monitoring Cellulitis | Erysipelas ▶BY INTRAVENOUS INFUSION ▶Adult: 15–20 mg/kg every 8–12 hours (max. per dose 2 g) adjusted according to plasma-concentration monitoring Complicated skin and soft tissue infections | Bone infections | Joint infections | Community-acquired pneumonia | Hospital-acquired pneumonia [including ventilator-associated pneumonia] | Infective endocarditis | Acute bacterial meningitis | Bacteraemia [occurring in association with or suspected to be associated with the licensed indications] ▶BY INTRAVENOUS INFUSION ▶Adult: 15–20 mg/kg every 8–12 hours (max. per dose 2 g) adjusted according to plasma-concentration monitoring, duration should be tailored to type and severity of infection and the individual clinical response—consult product literature for further information, in seriously ill patients, a loading dose of 25–30 mg/kg (usual max. 2 g) can be used to facilitate rapid attainment of the target trough serum- vancomycin concentration Perioperative prophylaxis of bacterial endocarditis [in patients at high risk of developing bacterial endocarditis when undergoing major surgical procedures] ▶BY INTRAVENOUS INFUSION ▶Adult: 15 mg/kg, to be given prior to induction of anaesthesia, a second dose may be required depending on duration of surgery Surgical prophylaxis (when high risk of MRSA) ▶BY INTRAVENOUS INFUSION ▶Adult: 1 g for 1 dose Peritonitis associated with peritoneal dialysis ▶BY INTRAPERITONEAL ADMINISTRATION ▶Adult: (consult local protocol)
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▶Vancomycin should not be given by mouth for systemic infections because it is not absorbed significantly. l UNLICENSED USE Vancomycin doses in BNF publications may differ from those in product literature. Use of vancomycin (added to dialysis fluid) for the treatment of peritonitis associated with peritoneal dialysis is an unlicensed route.
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▶With intravenous use Previous hearing loss
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▶With oral use systemic absorption may be enhanced in patients with inflammatory disorders of the intestinal mucosa or with Clostridioides difficile-induced pseudomembranous colitis (increased risk of adverse reactions)
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Caution if teicoplanin sensitivity.
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For choice of antibacterial therapy, see Antibacterials, use for prophylaxis p. 529, Blood infections, antibacterial therapy p. 532, Cardiovascular system infections, antibacterial therapy p. 532, Central nervous system infections, antibacterial therapy p. 533, Diabetic foot infections, Infection antibacterial therapy p. 533, Gastro-intestinal system infections, antibacterial therapy p. 535, Musculoskeletal system infections, antibacterial therapy p. 536, Respiratory system infections, antibacterial therapy p. 538, Skin infections, antibacterial therapy p. 540.
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→Appendix 1: vancomycin
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GENERAL SIDE-EFFECTS Agranulocytosis. dizziness. drug fever. eosinophilia. hypersensitivity. nausea. nephritis tubulointerstitial. neutropenia (more common after 1 week or cumulative dose of 25g). renal failure. severe cutaneous adverse reactions (SCARs). skin reactions. thrombocytopenia. tinnitus (discontinue). vasculitis. vertigo SPECIFIC SIDE-EFFECTS ▶With intravenous use Back pain. bradycardia. cardiac arrest (on rapid intravenous injection). cardiogenic shock (on rapid intravenous injection). chest pain. dyspnoea. hearing loss. hypotension. muscle complaints. pseudomembranous enterocolitis. red man syndrome. wheezing SIDE-EFFECTS, FURTHER INFORMATION Vancomycin is associated with a higher incidence of nephrotoxicity than teicoplanin.
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Manufacturer advises use only if potential benefit outweighs risk. Monitoring Plasma-vancomycin concentration monitoring Infection essential to reduce risk of fetal toxicity.
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Present in milk—significant absorption following oral administration unlikely.
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Manufacturer advises serial monitoring of renal function. ▶With intravenous use Manufacturer advises use with caution—increased risk of toxic effects with prolonged high blood concentration. Dose adjustments ▶With oral use Manufacturer advises dose adjustment is unlikely to be required unless substantial oral absorption occurs in inflammatory disorders of the intestinal mucosa or with Clostridioides difficile-induced pseudomembranous colitis, see Monitoring. ▶With intravenous use Manufacturer advises initial dose must not be reduced—consult product literature.
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▶With intravenous use Manufacturer advises initial doses should be based on body-weight; subsequent dose adjustments should be based on serum-vancomycin concentrations to achieve targeted therapeutic concentrations. All patients require serum-vancomycin measurement (on the second day of treatment, immediately before the next dose if renal function normal, earlier if renal impairment—consult product literature). Frequency of monitoring depends on the clinical situation and response to treatment; regular monitoring indicated in high-dose therapy and longer-term use, particularly in patients with impaired renal function, impaired hearing, or concurrent use of nephrotoxic or ototoxic drugs. Manufacturer advises pre-dose (‘trough’) concentration should normally be 10–20 mg/litre depending on the site of infection and the susceptibility of the pathogen; trough concentration of 15–20 mg/litre is usually recommended to cover susceptible pathogens with MIC greater than or equal to 1 mg/litre—consult product literature. ▶Manufacturer advises periodic testing of auditory function. Manufacturer advises monitor blood counts, urinalysis, hepatic and renal function periodically in all patients; monitor leucocyte count regularly in patients receiving long-term vancomycin or if given concurrently with other drugs that may cause neutropenia or agranulocytosis. ▶Manufacturer advises monitor vestibular and auditory function during and after treatment in the elderly; avoid concurrent or sequential use of other ototoxic drugs. ▶With oral use Manufacturer advises monitoring serum- vancomycin concentration in inflammatory intestinal disorders. ▶Manufacturer advises serial tests of auditory function may be helpful to minimise the risk of ototoxicity in patients with an underlying hearing loss, or who are receiving concomitant therapy with other ototoxic drugs.
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▶With intravenous use Avoid rapid infusion (risk of anaphylactoid reactions) and rotate infusion sites. For intravenous infusion, give intermittently in Glucose 5% or Sodium chloride 0.9%; reconstitute each 500 mg with 10 mL water for injections and dilute with infusion fluid to a concentration of up to 5 mg/mL (10 mg/mL in fluid restriction but increased risk of infusion-related effects); give over at least 60 minutes (rate not to exceed 10 mg/minute for doses over 500 mg); use continuous infusion only if intermittent not feasible. ▶With oral use Injection can be used to prepare solution for oral administration—consult product literature.
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There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension, oral solution, solution for injection, infusion Powder for solution for infusion ▶Vancomycin (Non-proprietary) Vancomycin (as Vancomycin hydrochloride) 500 mg Vancomycin 500mg powder for solution for infusion vials | 1 vial P £7.25 DT = £5.49 | 10 vial P £62.50 DT = £62.50 Vancomycin 500mg powder for concentrate for solution for infusion vials | 1 vial P £5.49–£8.50 DT = £5.49 (Hospital only) | 10 vial P £62.50 DT = £62.50 (Hospital only) | 10 vial P £62.50–£72.50 DT = £62.50 Vancomycin (as Vancomycin hydrochloride) 1 gram Vancomycin 1g powder for solution for infusion vials | 1 vial P £14.50 DT = £11.25 | 10 vial P £125.00 DT = £125.00 Vancomycin 1g powder for concentrate for solution for infusion vials | 1 vial P £11.25–£17.25 DT = £11.25 (Hospital only) | 10 vial P £125.00 DT = £125.00 (Hospital only) | 10 vial P £125.00 DT = £125.00 ▶Vancocin (Flynn Pharma Ltd) Vancomycin (as Vancomycin hydrochloride) 500 mg Vancocin 500mg powder for solution for infusion vials | 1 vial P £6.25 DT = £5.49 Vancomycin (as Vancomycin hydrochloride) 1 gram Vancocin 1g powder for solution for infusion vials | 1 vial P £12.50 DT = £11.25 Capsule CAUTIONARY AND ADVISORY LABELS 9 ▶Vancomycin (Non-proprietary) Vancomycin (as Vancomycin hydrochloride) 125 mg Vancomycin 125mg capsules | 28 capsule P £132.49 DT = £132.49 Vancomycin (as Vancomycin hydrochloride) 250 mg Vancomycin 250mg capsules | 28 capsule P £146.38 DT = £146.38 ▶Vancocin Matrigel (Flynn Pharma Ltd) Vancomycin (as Vancomycin hydrochloride) 125 mg Vancocin Matrigel 125mg capsules | 28 capsule P £88.31 DT = £132.49 ANTIBACTERIALS › LINCOSAMIDES
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125 mg every 6 hours for 10 days; increased if
First-line fragment. Read the complete Indications and Dose section above.
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125 mg every 6 hours for 10 days, followed by,
First-line fragment. Read the complete Indications and Dose section above.
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15–20 mg/kg every 8–12 hours (max. per dose
First-line fragment. Read the complete Indications and Dose section above.
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15–20 mg/kg every 8–12 hours (max. per dose
First-line fragment. Read the complete Indications and Dose section above.
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15–20 mg/kg every 8–12 hours (max. per dose
First-line fragment. Read the complete Indications and Dose section above.
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15 mg/kg, to be given prior to induction of
First-line fragment. Read the complete Indications and Dose section above.
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1 g for 1 dose
First-line fragment. Read the complete Indications and Dose section above.
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(consult local protocol)
First-line fragment. Read the complete Indications and Dose section above.
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