Vancomycin is indicated in potentially life-threatening infections which cannot be treated with other effective, less toxic antimicrobial drugs including penicillins and cephalosporins.

Vancomycin is useful in severe staphylococcal infections in patients who cannot receive or have failed to respond to penicillins and cephalosporins, or who have infections caused by resistant staphylococci.

Vancomycin is used in the treatment of endocarditis and as prophylaxis against endocarditis in patients undergoing dental or surgical procedures.

Its effectiveness has been documented in other staphylococcal infections including osteomyelitis, pneumonia, septicemia, and soft tissue infections.

Vancomycin binds tightly to the D-alanyl-D-alanine portion of the cell wall precursor, inhibiting glycopeptide polymerization. This leads to immediate inhibition of bacterial cell wall synthesis and secondary damage to the cytoplasmic membrane.

 Concentrations of no more than 5 mg/ml and infusion rates of no more than 10 mg/min are recommended. In selected patients requiring fluid restriction, a concentration up to 10 mg/ml may be used.

Patients with Normal Renal Function:

• Adults: The usual total daily dose is 2 g, administered in 2 or 4 divided doses.
• Children: The total daily dose is 40 mg/kg, given in 4 divided doses.
• Infants and neonates: An initial dose of 15 mg/kg is recommended, followed by 10 mg/kg every 12 hours during the first week, then every 8 hours up to 1 month of age.

Patients with Impaired Renal Function and Elderly Patients: Dosage adjustment is required in patients with impaired renal function. In premature infants and elderly patients, further dose reduction may be necessary due to decreased renal function. Dosage may be calculated based on creatinine clearance:

• CrCl 100 ml/min: 1545 mg/24 h
• CrCl 90 ml/min: 1390 mg/24 h
• CrCl 80 ml/min: 1235 mg/24 h
• CrCl 70 ml/min: 1080 mg/24 h
• CrCl 60 ml/min: 925 mg/24 h
• CrCl 50 ml/min: 770 mg/24 h
• CrCl 40 ml/min: 620 mg/24 h
• CrCl 30 ml/min: 465 mg/24 h
• CrCl 20 ml/min: 310 mg/24 h
• CrCl 10 ml/min: 155 mg/24 h

Important notes: The initial dose should not be less than 15 mg/kg, even in mild to moderate renal impairment. In anephric patients, an initial dose of 15 mg/kg should be given. Maintenance dose is approximately 1.9 mg/kg/24 h. In severe renal impairment, doses of 250–1000 mg may be given at intervals of several days. In anuria, 1000 mg every 7–10 days may be recommended. Intermittent infusion is recommended. Intraperitoneal administration is not recommended.

Capsule:

• Adults: The usual dosage for antibiotic-associated pseudomembranous colitis caused by C. difficile and staphylococcal enterocolitis is 125–500 mg orally every 6–8 hours for 7–10 days.
• Children: The usual daily dose is approximately 40 mg/kg in 3 or 4 divided doses for 7–10 days. The total daily dose should not exceed 2 g.

Vancomycin is contraindicated in patients with known hypersensitivity to Vancomycin.

Vancomycin is generally well tolerated. However, during or soon after rapid infusion, patients may develop anaphylactic reactions including hypotension, wheezing, dyspnoea, urticaria, or pruritus. Rapid infusion may also cause flushing of the upper body (“red neck”), pain, or muscle spasm of the chest and back. These reactions usually resolve within 20 minutes but may persist for several hours. They are uncommon when the drug is infused slowly over at least 60 minutes.

It is not known whether Vancomycin causes fetal harm. It should be used during pregnancy only if clearly needed, and blood levels should be carefully monitored to minimize the risk of fetal toxicity.

Vancomycin hydrochloride is excreted in human milk. Caution should be exercised when administered to nursing women. However, it is unlikely that a nursing infant absorbs a significant amount from the gastrointestinal tract.

Patients with borderline renal function and individuals over 60 years should undergo regular auditory function tests and monitoring of Vancomycin blood levels. Periodic hematological studies, urine analysis, and renal function tests are recommended for all patients.

Vancomycin is highly irritating to tissues and causes injection site necrosis if given intramuscularly. It must be administered intravenously. Injection site pain and thrombophlebitis are common and may occasionally be severe.

Prolonged use may result in overgrowth of non-susceptible organisms. Careful monitoring is required. If superinfection occurs, appropriate treatment should be started. Rarely, pseudomembranous colitis due to C. difficile has been reported.

Supportive care with maintenance of glomerular filtration is recommended. Vancomycin is poorly removed by haemodialysis or peritoneal dialysis. Haemoperfusion with Amberlite resin XAD-4 may provide limited benefit.

Other antibiotic

Store in a cool, dry place, protected from light. Keep out of reach of children.