Vancomycin

Aka: Vancomycin, Telavancin, Vibativ, First-Generation Glycopeptide Antibiotic

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II. 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

III. Preparations

  1. Standard agents
    1. Vancomycin
    2. Telavancin (Vibativ)
  2. Longer acting agents (released around 2014)
    1. See Lipoglycopeptide Antibiotics
    2. Dalbavancin (Dalvance)
      1. Infused over 30 minutes weekly
    3. Oritavancin (Orbactiv)
      1. Infused over 3 hours
      2. Single dose may be sufficient for MRSA Cellulitis
  3. References
    1. (2014) Presc Lett 21(8): 43

IV. Dosing: Parenteral Vancomycin

  1. Child
    1. Dose: 10 mg/kg/dose IV (over 1-2 hours) q6 hours
  2. Adult
    1. Dose: 15-20 mg/kg IV every 12 hours
    2. Precaution: 1 gram IV (over 1-2 hours) every 12 hours is only the dose for a 70 kg patient (but will be inadequate for a heavier patient)
    3. Consider dosing in 250 mg increments

V. 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

VI. Pharmacokinetics: Goal Levels

  1. Peak: 20-50 ug/ml
  2. Trough: 5-10 ug/ml

VII. 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
  3. Vancomycin is a large molecule that crosses the blood-brain barrier

VIII. 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)

IX. References

  1. Lacy (2000) Drug Information Handbook, Lexi-Comp

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Cost: Medications

vancomycin (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
VANCOMYCIN HCL 125 MG CAPSULE Generic $1.40 each
VANCOMYCIN HCL 250 MG CAPSULE Generic $1.98 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

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