Vancomycin is effective in the treatment of staphylococcal endocarditis. Its effectiveness has been documented in other infections due to staphylococci, including septicemia, bone infections, lower respiratory tract infections, skin and skin structure infections. When staphylococcal infections are localized and purulent, antibiotics are used as adjuncts to appropriate surgical measures.
Vancomycin is indicated for the treatment of serious or severe infections caused by susceptible strains of methicillin-resistant (beta-lactam-resistant) staphylococci. It is indicated for penicillin-allergic patients, for patients who cannot receive or who have failed to respond to other drugs, including the penicillins or cephalosporins, and for infections caused by vancomycin-susceptible organisms that are resistant to other antimicrobial drugs. Vancomycin is indicated for initial therapy when methicillin-resistant staphylococci are suspected, but after susceptibility data are available, therapy should be adjusted accordingly.
Vancomycin has been reported to be effective alone or in combination with an aminoglycoside for endocarditis caused by Streptococcus viridans or S. bovis. For endocarditis caused by enterococci (e.g., E. faecalis), vancomycin has been reported to be effective only in combination with an aminoglycoside.
Vancomycin has been reported to be effective for the treatment of diphtheroid endocarditis. Vancomycin has been used successfully in combination with either rifampin, an aminoglycoside, or both in early-onset prosthetic valve endocarditis caused by S. epidermidis or diphtheroids.
Specimens for bacteriologic cultures should be obtained in order to isolate and identify causative organisms and to determine their susceptibilities to vancomycin.
To reduce the development of drug-resistant bacteria and maintain the effectiveness of vancomycin and other antibacterial drugs, vancomycin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute
to the empiric selection of therapy.
PharmacoKinetics
Oral absorption of Vancomycin (HCl) is found to be 35.5% ±4.5. Volume of distribution is found to be 0.6 l/kg and plasma protien binding is 50 %. Renal Excretion accounts for 90 % and plasma half life is 5 - 11 hr.
DOSAGE AND ADMINISTRATION
Stability (Source: Lexi-drugs):
"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 D5W."
Vancomycin Adult Dosing and Monitoring
VANCOMYCIN DOSING
Vancomycin dosing is based on the patient’s actual body weight and requires adjustment in renal dysfunction.
* round dose to 250mg, 500mg, 750mg, 1g, 1.25g, 1.5g, 1.75g or 2g (maximum: 2gm/dose) Higher total daily doses of vancomycin have been associated with nephrotoxicity
1 For patients with uncomplicated infections requiring vancomycin, trough levels of 10-15 mcg/ml are recommended.
2 For patients with serious infections due to MRSA (central nervous system infections, endocarditis, ventilator-associated pneumonia, bacteremia or osteomyelitis) , trough levels of 15-20 mcg/ml are recommended. ID CONSULT IS RECOMMENDED.
Pediatric Patients: The usual intravenous dosage of vancomycin is 10 mg/kg per dose given every six hours.
Each dose should be administered over a period of at least 60 minutes.
Infants and Neonates: In neonates and young infants, the total daily intravenous dosage may be lower. In both neonates and infants, an initial dose of 15 mg/kg is suggested, followed by 10 mg/kg every 12 hours for neonates in the first week of life and every eight hours thereafter up to the age of one month. Each dose should be administered over 60 minutes. Close monitoring of serum concentrations of vancomycin may be warranted in these patients.
Patients with Impaired Renal Function and Elderly Patients
Dosage adjustment must be made in patients with impaired renal function. In premature infants and the elderly, greater dosage reductions than expected may be necessary because of decreased renal function. Measurement of vancomycin serum concentrations can be helpful in optimizing therapy, especially in seriously ill patients with changing renal function. Vancomycin serum concentrations can be determined by use of microbiologic assay, radioimmunoassay, fluorescence polarization immunoassay, fluorescence immunoassay, or high-pressure liquid chromatography.
If creatinine clearance can be measured or estimated accurately, the dosage for most patients with renal impairment can be calculated using the following table. The dosage of vancomycin per day in mg is about 15 times the glomerular filtration rate in mL/min:
For Oral Administration
Oral vancomycin is used in treating antibiotic-associated pseudomembranous colitis caused by C. difficile and for staphylococcal enterocolitis. Vancomycin is not effective by the oral route for other types of infections. The usual adult total daily dosage is 500 mg to 2 g given in 3 or 4 divided doses for 7 to 10 days. The total daily dosage in pediatric patients is 40 mg/kg of body weight in 3 or 4 divided doses for 7 to 10 days. The total daily dosage should not exceed 2 g. The appropriate dose may be diluted in 1 oz of water and given to the patient to drink. Common flavoring syrups may be added to the solution to improve the taste for oral administration. The diluted solution may be administered via a nasogastric tube.
Vancomycin side effects
Stop using vancomycin and call your doctor at once if you have any of these serious side effects:
Vancomycin is indicated for the treatment of serious or severe infections caused by susceptible strains of methicillin-resistant (beta-lactam-resistant) staphylococci. It is indicated for penicillin-allergic patients, for patients who cannot receive or who have failed to respond to other drugs, including the penicillins or cephalosporins, and for infections caused by vancomycin-susceptible organisms that are resistant to other antimicrobial drugs. Vancomycin is indicated for initial therapy when methicillin-resistant staphylococci are suspected, but after susceptibility data are available, therapy should be adjusted accordingly.
Vancomycin has been reported to be effective alone or in combination with an aminoglycoside for endocarditis caused by Streptococcus viridans or S. bovis. For endocarditis caused by enterococci (e.g., E. faecalis), vancomycin has been reported to be effective only in combination with an aminoglycoside.
Vancomycin has been reported to be effective for the treatment of diphtheroid endocarditis. Vancomycin has been used successfully in combination with either rifampin, an aminoglycoside, or both in early-onset prosthetic valve endocarditis caused by S. epidermidis or diphtheroids.
Specimens for bacteriologic cultures should be obtained in order to isolate and identify causative organisms and to determine their susceptibilities to vancomycin.
To reduce the development of drug-resistant bacteria and maintain the effectiveness of vancomycin and other antibacterial drugs, vancomycin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute
to the empiric selection of therapy.
PharmacoKinetics
Oral absorption of Vancomycin (HCl) is found to be 35.5% ±4.5. Volume of distribution is found to be 0.6 l/kg and plasma protien binding is 50 %. Renal Excretion accounts for 90 % and plasma half life is 5 - 11 hr.
DOSAGE AND ADMINISTRATION
Stability (Source: Lexi-drugs):
"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 D5W."
Vancomycin Adult Dosing and Monitoring
VANCOMYCIN DOSING
Vancomycin dosing is based on the patient’s actual body weight and requires adjustment in renal dysfunction.
| Creatinine Clearance (based on Cockcroft and Gault and not eGRF) | Dose* |
| >60 ml/min | 10-15 mg/kg q12h 1 15-20 mg/kg q8-12h (45-60mg/kg/day divided q12h or q8h) 2 |
| 40-60 ml/min | 10-15 mg/kg q12h-q24h |
| 20-40 ml/min | 5-10 mg/kg q24h |
| 10-20 ml/min | 5-10 mg/kg q24h-q48h |
| Hemodialysis | 15-20 mg/kg load, then 500 mg IV post HD only |
| CVVH | 10-15 mg/kg q24h |
* round dose to 250mg, 500mg, 750mg, 1g, 1.25g, 1.5g, 1.75g or 2g (maximum: 2gm/dose) Higher total daily doses of vancomycin have been associated with nephrotoxicity
1 For patients with uncomplicated infections requiring vancomycin, trough levels of 10-15 mcg/ml are recommended.
2 For patients with serious infections due to MRSA (central nervous system infections, endocarditis, ventilator-associated pneumonia, bacteremia or osteomyelitis) , trough levels of 15-20 mcg/ml are recommended. ID CONSULT IS RECOMMENDED.
Pediatric Patients: The usual intravenous dosage of vancomycin is 10 mg/kg per dose given every six hours.
Each dose should be administered over a period of at least 60 minutes.
Infants and Neonates: In neonates and young infants, the total daily intravenous dosage may be lower. In both neonates and infants, an initial dose of 15 mg/kg is suggested, followed by 10 mg/kg every 12 hours for neonates in the first week of life and every eight hours thereafter up to the age of one month. Each dose should be administered over 60 minutes. Close monitoring of serum concentrations of vancomycin may be warranted in these patients.
Patients with Impaired Renal Function and Elderly Patients
Dosage adjustment must be made in patients with impaired renal function. In premature infants and the elderly, greater dosage reductions than expected may be necessary because of decreased renal function. Measurement of vancomycin serum concentrations can be helpful in optimizing therapy, especially in seriously ill patients with changing renal function. Vancomycin serum concentrations can be determined by use of microbiologic assay, radioimmunoassay, fluorescence polarization immunoassay, fluorescence immunoassay, or high-pressure liquid chromatography.
If creatinine clearance can be measured or estimated accurately, the dosage for most patients with renal impairment can be calculated using the following table. The dosage of vancomycin per day in mg is about 15 times the glomerular filtration rate in mL/min:
For Oral Administration
Oral vancomycin is used in treating antibiotic-associated pseudomembranous colitis caused by C. difficile and for staphylococcal enterocolitis. Vancomycin is not effective by the oral route for other types of infections. The usual adult total daily dosage is 500 mg to 2 g given in 3 or 4 divided doses for 7 to 10 days. The total daily dosage in pediatric patients is 40 mg/kg of body weight in 3 or 4 divided doses for 7 to 10 days. The total daily dosage should not exceed 2 g. The appropriate dose may be diluted in 1 oz of water and given to the patient to drink. Common flavoring syrups may be added to the solution to improve the taste for oral administration. The diluted solution may be administered via a nasogastric tube.
Vancomycin side effects
Stop using vancomycin and call your doctor at once if you have any of these serious side effects:
- hearing loss, ringing in your ears;
- urinating less than usual or not at all;
- fever, chills, body aches, flu symptoms;
- feeling light-headed, fainting;
- skin rash, redness, bruising, severe tingling, numbness, pain, muscle weakness; or
- severe stomach pain, diarrhea that is watery or bloody.
Less serious vancomycin side effects may include:
- dizziness;
- nausea;
- back pain; or
- muscle pain or tightness.
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Unknown - Monday, 25 April 2011
