Names and pronunciation
(van-koe-mye′sin) Firvanq, Vancocin, Vancosol
Source page 1350
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Individual generic drug information
Extracted information for vancomycin only.
(van-koe-mye′sin) Firvanq, Vancocin, Vancosol
Source page 1350
Func. class.: Antiinfective— miscellaneous
Source page 1350
Chem. class.: Tricyclic glycopeptide
Source page 1350
ACTION: Inhibits bacterial cell-wall synthesis, blocks glycopeptides
Source page 1350
USES: Actinomyces sp., Bacillus sp., Clostridium difficile, Clostridium sp., Enterococcus faecalis, Enterococcus faecium, Enterococcus sp., Lactobacil lus sp., Listeria monocytogenes, Staphylococcus aureus (MRSA), Staph ylococcus aureus (MSSA), Staph ylococcus epidermidis, Staphylococcus sp., Streptococcus agalactiae (Group B), Streptococcus bovis, Streptococcus pneumoniae, Streptococcus pyogenes (group A beta-hemolytic streptococci), viridans streptococci; may be effective against Corynebacterium jeikeium, Corynebacterium sp., CDAD, staphy lococcal enterocolitis, endocarditis prophylaxis for dental procedures, bacteremia, joint/bone infections, osteomyelitis, pneumonia, septicemia
Source pages 1350, 1351
Unlabeled uses: Anthrax, intraabdom inal infections, diptheria, bone/joint in fections, surgical infection prophylaxis
Source page 1351
Extracted information for vancomycin only.
CONTRAINDICATIONS: Hyper sensitivity to this product or corn Precautions: Pregnancy, breastfeeding, neonates, geriatric patients, renal dis ease, hearing loss
Source page 1351
SIDE EFFECTS CNS: Headache CV: Hypotension, peripheral edema car- diac arrest, vascular collapse EENT: Ototoxicity, permanent deafness, tinnitus, nystagmus GI: Nausea, CDAD GU: Nephrotoxicity HEMA: Leukopenia, eosinophilia INTEG: Chills, fever, rash, thrombophlebi tis at inj site (red man syndrome), skin/ subcutaneous tissue disorders MS: Back pain RESP: Wheezing, dyspnea SYST: Anaphylaxis, superinfection
Source page 1352
INTERACTIONS Increase: ototoxicity/nephrotoxicity—ami noglycosides, cephalosporins, colistin, polymyxin, bactracin, cisplatin, amphoteri cin B, methotrexate, NSAIDs, cyclosporine, acyclovir, adefovir, foscarnet, ganciclovir, pamidroate, IV pentamine, streptozocin, tacrolimus, zoledronic acid; do not use with cholestyramine, colestipol, cidofovir Increase: lactic acidosis—metformin Increase: neuromuscular effects—non depolarizing muscle relaxants Drug/Lab Test Increase: BUN/creatinine, eosinophils Decrease: WBC
Source page 1352
Extracted information for vancomycin only.
DOSAGE AND ROUTES Serious systemic infections • Adult: IV 500 mg q6-8hr or 1 g q12hr or 15-20 mg/kg q12hr • Child: IV 40-60 mg/kg/day divided q6-8hr • Neonate: IV 15 mg/kg initially, then 10 mg/kg q8-24hr CDAD • Adult: PO 125 mg qid × 10-14 days • Child: PO (unlabeled) 40 mg/kg/day divided q6hr × 7-10 days, max 2 g/day Staphylococcal endocarditis prophylaxis • Adult: IV 2 g divided (500 mg q6hr, or 1 g q12hr) • Child: IV 20 mg/kg over 1 hr given 1 hr before procedure Staphylococcal enterocolitis • Adult: IV PO 500-2000 mg/day in 3-4 divided doses × 7-10 days • Child PO: 40 mg/kg/day in 3-4 divided doses × 7-10 days, max 2000 mg/day Renal dose • Adult: IV 15-20 mg/kg loading dose in seriously ill; individualize all other doses
Source page 1351
Available forms: Cap 125, 250 mg; powder for inj 500 mg, 750 mg, 1 g; dextrose sol for inj 500 mg/100 mL, 750 mg/150 mL, 1 g/200 mL, powder for oral solution 25 mg/mL, 50 mg/mL
Source page 1351
Administer: • Obtain C&S before use, use only for susceptible organisms to prevent prod uct-resistant bacteria • Antihistamine if red man syndrome occurs: decreased B/P; flushing of neck, face; stop or slow infusion • Dose based on serum concentration IT route • Dilute with preservative-free normal saline (1-5 mg/mL), give into ventricular cerebrospinal fluid • PO: without regard to food, swallow whole (used only for Clostridium difficile, staphylococcal enterocolitis) • Use calibrated measuring device for liquid • IV form may be used NG after diluting in 30 mL water • Store at room temperature for ≤2 wk after reconstitution Intermittent IV INFUSION route • After reconstitution with 10 mL sterile water for inj (500 mg/10 mL, 750 mg/15 mL, 1 g/20 mL); further dilution is needed for IV, 500 mg/100 mL, 750 mg/150 mL, 1 g/200 mL 0.9% NaCl, D5W given as inter mittent infusion over 1 hr; decrease rate of infusion if red man syndrome occurs Continuous IV INFUSION route (unlabeled) • May infuse 1-2 g in volume to give over 24 hr if intermittent IV route can not be used • A central line may be considered for long-term therapy, assess peripheral lines for phlebitis Y-site compatibilities: Acetylcysteine, acyclovir, alatrofloxacin, aldesleukin, alemtuzumab, alfentanil, allopurinol, V alprostadil, amifostine, amikacin, amino acids injection, aminocaproic acid, amiodarone, amoxicillin-clavula nate, amsacrine, anidulafungin, arg atroban, ascorbic acid injection, aten olol, atracurium, atropine, azithromycin, benztropine, bleomycin, bretylium, bumetanide, buprenor phine, butorphanol, calcium chloride/ gluconate, CARBOplatin, carmustine, caspofungin, cefpirome, chlorproMA ZINE, cimetidine, ciprofloxacin, cisa tracurium, CISplatin, clarithromycin, clindamycin, codeine, cyanocobala min, cyclophosphamide, cyclo SPORINE, cytarabine, DACTINomycin, DAUNOrubicin liposome, dexametha sone, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, dolasetron, DOPamine, doripenem, doxacurium, doxapram, DOXOrubicin, DOXOrubi cin liposomal, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, etoposide phos phate, famotidine, fenoldopam, fen taNYL, filgrastim, fluconazole, fludara bine, folic acid (as sodium salt), gallium, gemcitabine, gentamicin, glyco pyrrolate, granisetron, HYDROmorphone, hydrOXYzine, ifosfamide, insulin (regu lar), irinotecan, isoproterenol, isosor bide, ketamine, labetalol, lactated Ringer’s injection, lepirudin, levofloxacin, lido caine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, mel phalan, meperidine, meropenem, meta raminol, methyldopate, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, minocycline, mitoXANtrone, morphine, multiple vitamins injection, mycophenolate, nalbuphine, naloxone, nesiritide, netilmicin, niCARdipine, nitro glycerin, nitroprusside, norepinephrine, octreotide, ofloxacin, ondansetron, oxa cillin, oxaliplatin, oxytocin, PACLitaxel (solvent/surfactant), palonosetron, pami dronate, pancuronium, papaverine, PEMEtrexed, penicillin G potassium/ sodium, pentamidine, pentazocine, PEN Tobarbital, perphenazine, PHENobarbital, phentolamine, phenylephrine, phytonadi one, piritramide, polymyxin B, potassium acetate/chloride, procainamide, prochlor perazine, promethazine, propranolol, protamine, pyridoxine, quiNIDine, raniti dine, remifentanil, rifampin, Ringer’s injection, riTUXimab, sodium acetate/ bicarbonate/citrate, succinylcholine, SUFentanil, tacrolimus, teniposide, thia mine, thiotepa, tigecycline, tirofiban, TNA (3-in-1), tobramycin, tolazoline, TPN (2-in-1), trastuzumab, urapidil, vasopres sin, vecuronium, verapamil, vinBLAStine, vinCRIStine, vinorelbine, voriconazole, zidovudine, zoledronic acid
Source pages 1351, 1352
Extracted information for vancomycin only.
Assess: • Infection: WBC, urine, stools, sputum, characteristics of wound throughout treat ment; obtain C&S before starting treatment, may start treatment before results are received • Nephrotoxicity: I&O ratio; report he- maturia, oliguria; nephrotoxicity may occur; BUN, creatinine • Serum levels: peak 1 hr after 1-hr infu sion 25-40 mg/L, trough before next dose 5-10 mg/L, especially in renal disease; no trough levels are needed for oral form • CDAD: watery or bloody diarrhea, abdominal cramps, fever, pus, mucus, nau- sea, dehydration; discontinue immediately • Auditory function during, after treat ment; hearing loss, ringing, roaring in ears; product should be discontinued • B/P during administration; sudden drop may indicate red man syndrome • Skin eruptions • Red man syndrome: flushing of neck, face, upper body, arms, back, may lead to anaphylaxis; slow IV infusion to >1 hr • EPINEPHrine, suction, tracheostomy set, endotracheal intubation equipment on unit; anaphylaxis may occur • Adequate intake of fluids (2 L/day) to prevent nephrotoxicity
Source page 1353
Evaluate: • Therapeutic response: absence of fe ver, sore throat; negative culture
Source page 1353
CLINICAL CONSIDERATIONS
Source page 1353
Patient and caregiver information: • About all aspects of product therapy; about the need to complete entire course of medication to ensure organism death (7-10 days); that culture may be taken after completed course of medication • To report sore throat, fever, fatigue; could indicate superinfection • That product must be taken in equal inter vals around the clock to maintain blood levels • That labs will need to be regularly monitored with IV infusion • To notify prescriber if there is no change in 72-96 hr • That antiinfectives must be taken be fore dental/medical invasive procedures in rheumatic heart disease • Pregnancy/breastfeeding: identify if pregnancy is planned or suspected or if breastfeeding HIGH ALERT
Source page 1353
Extracted information for vancomycin only.
PHARMACOKINETICS Widely distributed, crosses placenta, penetration in CSF (20%-30%) PO: Absorption poor IV: Onset rapid, peak 1 hr, half-life 4-8 hr, excreted in urine (active form) Pediatric elimination half-lives: Newborns 6.7 hr, infant 1 mo-1 yr: 4.1 hr; child 2.5-11 yr: 5.6 hr
Source page 1352
Filter the extracted dose blocks for this individual drug.
Serious systemic infections
• Adult: IV 500 mg q6-8hr or 1 g q12hr or 15-20 mg/kg q12hr
Candidate age grouping · source page 1351
Serious systemic infections
• Child: IV 40-60 mg/kg/day divided q6-8hr
Candidate age grouping · source page 1351
Serious systemic infections
• Neonate: IV 15 mg/kg initially, then 10 mg/kg q8-24hr CDAD
Candidate age grouping · source page 1351
Serious systemic infections
• Adult: PO 125 mg qid × 10-14 days
Candidate age grouping · source page 1351
Serious systemic infections
• Child: PO (unlabeled) 40 mg/kg/day divided q6hr × 7-10 days, max 2 g/day Staphylococcal endocarditis prophylaxis
Candidate age grouping · source page 1351
Serious systemic infections
• Adult: IV 2 g divided (500 mg q6hr, or 1 g q12hr)
Candidate age grouping · source page 1351
Serious systemic infections
• Child: IV 20 mg/kg over 1 hr given 1 hr before procedure Staphylococcal enterocolitis
Candidate age grouping · source page 1351
Serious systemic infections
• Adult: IV PO 500-2000 mg/day in 3-4 divided doses × 7-10 days
Candidate age grouping · source page 1351
Serious systemic infections
• Child PO: 40 mg/kg/day in 3-4 divided doses × 7-10 days, max 2000 mg/day Renal dose
Candidate age grouping · source page 1351
Serious systemic infections
• Adult: IV 15-20 mg/kg loading dose in seriously ill; individualize all other doses
Candidate age grouping · source page 1351