Infectious Disease Book

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Vancomycin

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  1. Indications
    1. First Line Agent
      1. Methicillin-resistant Staphylococcus aureus
      2. Staphylococcus epidermidis (non-contaminant)
      3. Bacillus cereus
      4. Corynebacterium jeikeium
      5. Chryseobacterium
    2. Second Line Agent
      1. Clostridium difficile
      2. Enterococcus faecalis
      3. Methicillin-susceptible Staphylococcus aureus
  2. Dosing: Parenteral Vancomycin
    1. Adult: 1 gram IV (given over 1 hour) every 12 hours
    2. Child: 10 mg/kg/dose IV (given over 1 hour) q6 hours
  3. Dosing: Oral Vancomycin for Clostridium difficile
    1. Second-line agent in Pseudomembranous colitis
    2. Adult Dose: 125 mg PO qid for 10 days
    3. Child Dose: 40 mg/kg/day PO divided qid
    4. Newborn Dose: 10 mg/kg/day PO divided qid
  4. Pharmacokinetics: Goal Levels
    1. Peak: 20-50 ug/ml
    2. Trough: 5-10 ug/ml
  5. 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
  6. Adverse Effects
    1. Excessive Histamine release (rapid infusion)
      1. Angioedema
      2. Flushed skin
      3. Hypotension
    2. Toxicity if co-administered with Aminoglycoside
      1. Ototoxicity
      2. Nephrotoxicity
    3. Neutropenia
    4. Rash
    5. IgA Bullous Dermatosis (rare)
  7. References
    1. Lacy (2000) Drug Information Handbook, Lexi-Comp

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