Vancomycin

Vancomycinis aprescription drugused to treat a certain intestinal condition (colitis) that may rarely happen after treatment with antibiotics. This condition causes diarrhea and stomach/abdominal pain. When vancomycin is taken by mouth, it stays in the intestines to stop the growth of bacteria that cause these symptoms.

Thisantibiotictreats only bacterial infection in the intestines. It will not work for bacterial infections in any other part of the body or for viral infections (such ascommon cold, flu). Using any antibiotic when it is not needed can cause it to not work for future infections.

Dosage of Vancomycin:

Adult and pediatric dosages:

Capsule

• 125 mg
• 250 mg

Injectable solution

• 5 mg/solution

Powder for injection

• 500 mg
• 750 mg
• 1 g
• 5 g
• 10 g

Dosage Considerations – Should be Given as Follows:

Pseudomembranous Colitis/Staphylococcal Enterocolitis

• C. difficile: 125 mg orally every 6 hours for 10 days
• S. enterocolitis: 0.5-2 g/day orally divided every 6-8 hours for 7-10 days
• Because of the cost of capsules, the intravenous solution is sometimes compounded for oral use

Endocarditis

Adults

• Treatment: 500 mg intravenously every 6 hours or 1 g intravenously every 12 hours
• Used for staphylococcal, streptococcal, and diphtheroid endocarditis; current American Heart Association (AHA) guidelines recommend using only for high-risk patients

  Pediatric

• Children older than 1 month: 15 mg/kg followed by 10 mg/kg intravenously every 12 hours for neonates in the first week of life and every 8 hours thereafter up to 1 month of age; longer dosing intervals are recommended in premature infants
• Infants under 1 month: 10 mg/kg/day intravenously divided every 6 hours; individual dose not to exceed 1 g
• Current American Heart Association guidelines recommend using only for high-risk patients

PreoperativeAntimicrobialProphylaxis(Off-label)

Adult

• Gastrointestinal(GI) andgenitourinary(GU) procedures: 1 g intravenously by slow infusion over 1 hour, beginning 1-2 hours before procedure (with or withoutgentamicin1.5 mg/kg; not to exceed 120 mg intravenously or intramuscularly less than 30 minutes before the procedure)

Pediatric

• Gastrointestinal (GI) and genitourinary (GU) procedures: 20 mg/kg intravenously by slow infusion over 1 hour, beginning 1 hour before the procedure (with or without gentamicin 1.5 mg/kg; not to exceed 120 mg intravenously orintramuscularless than 30 minutes before the procedure)

Surgical Prophylaxis (Off-label)

• Prophylaxis of infection in cardiac,thoracic, and arterial procedures; craniotomy; joint replacement;amputation
• 15 mg/kg intravenously over 1-2 hours; begin administration within 2 hours beforeincision; duration of prophylaxis for most procedures should be less than 24 hours

BacterialMeningitis(Pediatric)

• 15-20 mg/kg intravenously every 6 hours

Pseudomembranous Colitis (Pediatric)

• 40 mg/kg/day orally divided every 608 hours for 7-10 days, not to exceed 2 g/day

Other Infections (Pediatric)

• 40 mg/kg/day intravenously divided every 6 hours

Dosing Modifications

• Renal impairment: 15 mg/kg initially; further doses are based on renal function, serum drug level, and institutional protocol; dosing intervals range from every 24 hours to every 96 hours, depending on the severity of impairment

Dosing Considerations

Adults

Pediatric

• General dosing recommendation: 2 g/day intravenously divided every 6-12 hours; maybe increased on basis of body weight or to achieve higher trough values; increased toxicity at dosage over 4 g/day
• Peak values 18-26 mg/L; trough values 5-10 mg/L; however, Infectious Diseases Society of America and other guidelines urge troughs 15-20 mg/L

Neonataldosing

• Infant less than 7 days and under 1.2 kg: 15 mg/kg intravenously once daily; monitor serum levels and adjust the dose
• Infant less than 7 days and 1.2-2 kg: 10-15 mg/kg intravenously every 12-18 hours; monitor serum levels and adjust the dose
• Infant less than 7 days and over 2.1 kg: 10-15 mg/kg intravenously every 8-12 hours; monitor serum levels and adjust the dose
• Infants older than 7 days and less than 1.2 kg: 15 mg/kg intravenously every 24 hours; monitor serum levels and adjust the dose
• Infants older than 7 days and 1.2-2 kg: 10-15 mg/kg intravenously every 8-12 hours; monitor serum levels and adjust the dose
• Infants older than 7 days and over 2.1 kg: 15-20 mg/kg intravenously every 8 hours; monitor serum levels and adjust the dose

Side effects of vancomycin include:

• bitter taste
• reddish rash on face and upper body (intravenously: red neck or red man syndrome, related to infusion rate)
• low blood pressureaccompanied by flushing
• nausea
• vomiting
• chills
• drug fever
• high levels of white blood cells (eosinophilia)
• rash
• fatigue
• swelling of hands and feet
• urinary tract infection
• back pain
• headache
• reversible low white cell countneutropenia
• inflammation of a vein (phlebitis)
• kidney damage
• damage to the inner ear (especially large doses)
• Steven-Johnson syndrome
• low platelet level (thrombocytopenia)
• inflammation of the blood vessels (vasculitis)
• wheezing
• low blood pressure
• shortness of breath
• hives
• itching

Postmarketing side effects of Vancomycin reported include:

• Ototoxicity: Hearing loss associated intravenous administration (most cases had a coexisting renal impairment or pre-existing hearing loss, or were coadministered an ototoxic drug), poor balance (vertigo), dizziness, andringing in the ears(tinnitus)
• Hematopoietic: Reversible neutropenia, thrombocytopenia
• Miscellaneous: an allergic reaction (anaphylaxis), drug fever, chills, nausea, eosinophilia, rashes,Stevens-Johnson syndrome,toxic epidermal necrolysis, and vasculitis

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

Vancomycin has no known severe interactions with other drugs.

Serious interactions of vancomycin include:

• bacitracin
• BCG vaccinelive
• cholera vaccine
• typhoid vaccine live

Vancomycin has moderate interactions with at least 30 different drugs.

Vancomycin has minor interactions with at least 55 different drugs.

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns, or for more information about this medicine.

Warnings

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately

Contraindications

• Hypersensitivity

Effects of Drug Abuse

• No information available

Short-Term Effects

• See "What Are Side Effects Associated with Using Vancomycin?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Vancomycin?"

Cautions

• Rapid intravenous administration may result in flushing, severe itching, low blood pressure, reddening of the skin, and hives
• Systemic vancomycin exposure may result in acute kidney injury (AKI); the risk of AKI increases as systemic exposure/serum levels increase; additional risk factors for AKI in patients vancomycin include receipt of concomitant drugs known to be kidney damage, in patients with pre-existing renal impairment or with co-morbidities that使对肾impairment;interstitialinflammation of the kidneys also reported in patients receiving vancomycin
• Endocarditis prophylaxis: Use only for high-risk patients, per American Heart Association guidelines
• 不清楚药物损害肾脏or damaging to the brain or nervous system in regular doses but increased kidney damage and inner ear damage are associated with pre-existing kidney (renal) impairment, advanced age, dehydration; also appears to potentiate kidney-/braintoxic effects of other drugs
• Damage to the inner ear (ototoxicity) may occur; toxicity proportional to the amount of drug given and duration of treatment; the presence of ringing in the ears (tinnitus) or loss of balance (vertigo) may indicate injury to parts of the middle ear; discontinue if signs of ototoxicity occur
• Risk of neutropenia increases with doses greater than 25 g (reversible following discontinuation of therapy)
• Avoid extravasation;necrosismay occur
• Prolonged use may result in fungal or bacterial superinfection
• Use caution in patients with renal impairment; monitor trough concentrations if multiple oral doses administered
• Oral vancomycin only indicated for the treatment of pseudomembranous colitis due toC. difficileand enterocolitis due toS. aureus; not effective for systemic infections

Pregnancy and Lactation

• 怀孕期间使用静脉注射万古霉素caution if benefits outweigh risks
• Animal studies show risk and human studies are not available, or neither animal nor human studies were done
• Use of oral vancomycin during pregnancy may be acceptable
• Either animal studies show no risk but human studies not available or animal studies showed minor and human studies were done and showed no risk
• Vancomycin enters breast milk; it is not recommended when breastfeeding