Vancomycin

A to Z Drug Facts

 Action Inhibits bacterial cellwall synthesis and alters cell-membrane permeability and RNA synthesis.

 Indications

Parenteral: Treatment of serious or severe infections due to susceptible bacteria not treatable with other antimicrobials (eg, staphylococcus). Oral: Treatment of pseudomembranous colitis caused by Clostridium difficile; treatment of staphylococcal enterocolitis. Unlabeled use(s): IV prophylaxis against bacterial endocarditis in penicillin-allergic patients.

 Contraindications Standard considerations.

 Route/Dosage

ADULTS: PO 500 mg to 2 g/day in 3 or 4 divided doses for 7 to 10 days. CHILDREN: PO 40 mg/kg/day (up to 2 gm/day) in 3 or 4 divided doses for 7 to 10 days. NEONATES: PO 10 mg/kg/day in divided doses. ADULTS: IV 500 mg by IV infusion q 6 hr or 1 g q 12 hr. CHILDREN: IV 10 mg/kg/dose q 6 hr. INFANTS & NEONATES: IV 15 mg/kg initially, followed by 10 mg/kg q 12 hr for neonates in first week of life, and q 8 hr for ages up to 1 month.

 Interactions

Aminoglycosides: May increase risk of nephrotoxicity. Neurotoxic and nephrotoxic agents: May give additive toxicity. Nondepolarizing muscle relaxants: Neuromuscular blockade may be enhanced. IV solution is incompatible with alkaline injections.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Hypotension. DERM: Rash; urticaria; pruritus; inflammation at site of injection. EENT: Hearing loss. GI: Nausea. Increased serum creatinine and BUN; renal failure. HEMA: Neutropenia; eosinophilia. RESP: Wheezing; dyspnea. OTHER: Anaphylaxis; drug fever; chills; Red Man Syndrome (hypotension with or without rash over face, neck, upper chest, and extremities).

 Precautions

Pregnancy: Category C. Lactation: Excreted in breast milk. Children: Confirming serum levels may be appropriate in neonates. Use of vancomycin with anesthetics may cause erythema and flushing. Special risk patients: Use with caution in patients with pre-existing hearing loss, patients receiving ototoxic or nephrotoxic drugs, patients receiving drugs that cause neutropenia; patients with renal impairment; elderly; and neonates. Hypotension: Too rapid IV infusion or bolus administration may be associated with exaggerated hypotension, including shock and cardiac arrest, with or without maculopapular rash over face, neck, upper chest and extremities (Red Man or Redneck syndrome). Reaction has been rarely associated with slow infusion or oral or intraperitoneal administration. Reversible neutropenia: May occur after total dose of 25 g. Tissue irritation, thrombophlebitis: Give by secure IV route. May minimize thrombophlebitis by giving slowly as dilute infusion.

 Administration/Storage

• Prepare oral solution by adding 115 ml of water to 10 g vial or 20 ml of water to 1 g vial. Further dilute prepared oral solution dose with 30 ml of water or flavoring syrups may be used with oral solution.
• May give oral solution via nasogastric tube as indicated or ordered.
• Reconstitute parenteral form with Sterile Water for Injection.
• Further dilute parenteral medication with compatible solution (eg, 5% Dextrose Injection, 0.9% Sodium Chloride, Lactated Ringer's)
• Parenteral form may be administered by oral route.
• Reconstituted oral solution may be stored in refrigerator for 2 wk after bottle is opened.
• Dilute to minimum dilution of 2.5 to ml and infuse parenteral solution over at least 60 min. Intermittent infusion preferred.
• Pretreat with antihistamine if patient has previously experienced Red Man Syndrome.
• Dosage or dosage interval may be changed based upon vancomycin serum levels.
• Reconstituted powder for injection is stable at room temperature for 2 wk.
• Dilute solutions (sodium chloride or D5W) are stable at room temperature for 24 hr.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Assess results of culture and sensitivity to determine sensitivity.
• Assess hearing acuity before and after therapy. Anticipate ototoxicity.
• Monitor for signs of superinfection.
• Monitor skin for Red Man Syndrome with each dose infused.
• Notify health care provider of elevated BUN and creatinine, which indicate nephrotoxicity.
• Document hematuria and notify health care provider.
• Monitor I & O, BP for hypotension, and respirations for wheezing or dyspnea.
• Maintain adequate fluid intake.
• Obtain blood levels, new order or protocol. Keep blood levels between 10 to 20 mcg/ml.
• Ensure that resuscitation equipment is available.

 Patient/Family Education

• Explain that IV medication is given at regular intervals to maintain blood levels.
• Tell patient to report hearing loss, ringing in ears, or vertigo to health care provider.
• Explain signs of superinfection (eg, vaginitis).
• Identify symptoms of potential adverse reactions.
• Tell patient to maintain adequate fluid intake.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts