Yes

Antibiotic, Miscellaneous

Treatment of patients with infections caused by staphylococcal species and streptococcal species; used orally for staphylococcal enterocolitis or for antibiotic-associated pseudomembranous colitis produced by C. difficile

C

Hypersensitivity to vancomycin or any component; avoid in patients with previous severe hearing loss

Use with caution in patients with renal impairment or those receiving other nephrotoxic or ototoxic drugs; dosage modification required in patients with impaired renal function (especially elderly)

Oral:

>10%: Gastrointestinal: Bitter taste, nausea, vomiting

1% to 10%:

Central nervous system: Chills, drug fever

Hematologic: Eosinophilia

<1%: Vasculitis, thrombocytopenia, ototoxicity, renal failure, interstitial nephritis

Parenteral:

>10%:

Cardiovascular: Hypotension accompanied by flushing

Dermatologic: Erythematous rash on face and upper body (red neck or red man syndrome - infusion rate related)

1% to 10%:

Central nervous system: Chills, drug fever

Dermatologic: Rash

Hematologic: Eosinophilia, reversible neutropenia

<1%: Vasculitis, Stevens-Johnson syndrome, ototoxicity (especially with large doses), thrombocytopenia, renal failure (especially with renal dysfunction or pre-existing hearing loss)

Symptoms of overdose include ototoxicity, nephrotoxicity

There is no specific therapy for an overdosage with vancomycin. Care is symptomatic and supportive in nature. Peritoneal filtration and hemofiltration (not dialysis) have been shown to reduce the serum concentration of vancomycin; high flux dialysis may remove up to 25%.

Increased toxicity: Anesthetic agents; other ototoxic or nephrotoxic agents

Vancomycin reconstituted intravenous solutions are stable for 14 days at room temperature or refrigeration

Stability of parenteral admixture at room temperature (25°C) or refrigeration temperature (4°C): 7 days

Standard diluent: 500 mg/150 mL D₅W; 750 mg/250 mL D₅W; 1 g/250 mL D ₅W

Minimum volume: Maximum concentration is 5 mg/mL to minimize thrombophlebitis

Incompatible with heparin, phenobarbital

After the oral solution is reconstituted, it should be refrigerated and used within 2 weeks

Inhibits bacterial cell wall synthesis by blocking glycopeptide polymerization through binding tightly to D-alanyl-D-alanine portion of cell wall precursor

Absorption:

Oral: Poor

I.M.: Erratic

Intraperitoneal: Can result in 38% absorption systemically

Distribution: Widely distributed in body tissues and fluids except for CSF

Relative diffusion of antimicrobial agents from blood into cerebrospinal fluid (CSF): Good only with inflammation (exceeds usual MICs)

Ratio of CSF to blood level (%): Normal meninges: Nil; Inflamed meninges: 20-30

Protein binding: 10%-50%

Half-life (biphasic): Terminal:

Newborns: 6-10 hours

Infants and Children 3 months to 4 years: 4 hours

Children >3 years: 2.2-3 hours

Adults: 5-11 hours, prolonged significantly with reduced renal function

End-stage renal disease: 200-250 hours

Time to peak serum concentration: I.V.: Within 45-65 minutes

Elimination: As unchanged drug in the urine via glomerular filtration (80% to 90%); oral doses are excreted primarily in the feces

Initial dosage recommendation: I.V.:

Postnatal age less than or equal to 7 days:

<1200 g: 15 mg/kg/dose every 24 hours

1200-2000 g: 10 mg/kg/dose every 12 hours

>2000 g: 15 mg/kg/dose every 12 hours

Postnatal age >7 days:

<1200 g: 15 mg/kg/dose every 24 hours

greater than or equal to 1200 g: 10 mg/kg/dose divided every 8 hours

Infants >1 month and Children:

40 mg/kg/day in divided doses every 6 hours

Prophylaxis for bacterial endocarditis:

Dental, oral, or upper respiratory tract surgery: 20 mg/kg 1 hour prior to the procedure

GI/GU procedure: 20 mg/kg plus gentamicin 2 mg/kg 1 hour prior to surgery

Infants >1 month and Children with staphylococcal central nervous system infection: 60 mg/kg/day in divided doses every 6 hours

Adults:

With normal renal function: 1 g or 10-15 mg/kg/dose every 12 hours

Prophylaxis for bacterial endocarditis:

Dental, oral, or upper respiratory tract surgery: 1 g 1 hour before surgery

GI/GU procedure: 1 g plus 1.5 mg/kg gentamicin 1 hour prior to surgery

Dosing interval in renal impairment (vancomycin levels should be monitored in patients with any renal impairment):

Cl_cr >60 mL/minute: Start with 1 g or 10-15 mg/kg/dose every 12 hours

Cl_cr 40-60 mL/minute: Start with 1 g or 10-15 mg/kg/dose every 24 hours

Cl_cr <40 mL/minute: Will need longer intervals; determine by serum concentration monitoring

Hemodialysis: Not dialyzable (0% to 5%); generally not removed; exception minimal-moderate removal by some of the newer high-flux filters; dose may need to be administered more frequently; monitor serum concentrations

Continuous ambulatory peritoneal dialysis (CAPD): Not significantly removed; administration via CAPD fluid: 15-30 mg/L (15-30 mcg/mL) of CAPD fluid

Continuous arteriovenous hemofiltration: Dose as for Cl_cr 10-40 mL/minute

Antibiotic lock technique (for catheter infections): 2 mg/mL in SWI/NS or D₅W; instill 3-5 mL into catheter port as a flush solution instead of heparin lock ( Note: Do not mix with any other solutions)

Intrathecal: Vancomycin is available as a powder for injection and may be diluted to 1-5 mg/mL concentration in preservative-free 0.9% sodium chloride for administration into the CSF

Neonates: 5-10 mg/day

Children: 5-20 mg/day

Adults: Up to 20 mg/day

Oral: Pseudomembranous colitis produced by C. difficile:

Neonates: 10 mg/kg/day in divided doses

Children: 40 mg/kg/day in divided doses, added to fluids

Adults: 125 mg 4 times/day for 10 days

May be administered with food

Periodic renal function tests, urinalysis, serum vancomycin concentrations, WBC, audiogram

Timing of serum samples: Draw peak 1 hour after 1-hour infusion has completed; draw trough just before next dose

Therapeutic levels: Peak: 25-40 mg/mL; Trough: 5-12 mg/mL

Toxic: >80 mg/mL (SI: >54 mmol/L)

None reported

May cause neutropenia; use caution with clozapine and carbamazepine

No information available to require special precautions

No effects or complications reported

Oral: Take per recommended schedule. Complete full course of therapy; do not skip doses. Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). You may experience nausea, vomiting, or GI upset (small frequent meals, frequent mouth care, sucking lozenges, or chewing gum may help).

Oral or I.V.: Report chills or pain at infusion site, skin rash or redness, decrease in urine output, chest pain or palpitations, persistent GI disturbances, signs of opportunistic infection (sore throat, chills, fever, burning, itching on urination, vaginal discharge, white plaques in mouth), difficulty breathing, changes in hearing or fullness in ears, or worsening of condition.

Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Consult prescriber if breast-feeding.

Obtain drug levels after the third dose unless otherwise directed; peaks are drawn 1 hour after the completion of a 1- to 2-hour infusion; troughs are obtained just before the next dose; slow I.V. infusion rate if maculopapular rash appears on face, neck, trunk, and upper extremities (Red man reaction)

Capsule, as hydrochloride: 125 mg, 250 mg

Powder for oral solution, as hydrochloride: 1 g, 10 g

Powder for injection, as hydrochloride: 500 mg, 1 g, 2 g, 5 g, 10 g

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