Intravenous Severe staphylococcal infections, Susceptible Gram-positive infections
Adult: 15-20 mg/kg 8-12 hourly via slow infusion over 60 minutes at Max rate of 10 mg/min. Max: 2,000 mg daily. Loading dose for severe cases: 25-50 mg/kg. Doses are adjusted according to plasma-concentration monitoring. Duration of treatment is based on the severity of infection and individual clinical response, refer to detailed product guideline. Child: Neonates dosage is based on post-menstrual age in weeks, refer to detail product guideline; 1 month to<12 years 10-15 mg/kg 6 hourly; ≥12 years Same as adult dose. Elderly: Dose reduction may be required.
Intravenous Prophylaxis of endocarditis
Adult: In patients at high risk of developing bacterial endocarditis in surgery: 15 mg/kg given prior to induction of anaesthesia. May repeat dosage depending on the duration of surgery. Elderly: Dose reduction may be required.
Oral Staphylococcal enterocolitis
Adult: 500 mg to 2,000 mg in 3-4 divided doses for 7-10 days. Child: 40 mg/kg in 3-4 divided doses for 7-10 days. Max: 2,000 mg daily.
Adult: 1st episode of non-severe cases: 125 mg 6 hourly for 10 days, may increase dose to 500 mg 6 hourly for 10 days for severe and complicated cases. Max: 2,000 mg daily. For multiple recurrences: 125 mg 4 times daily for 10 days followed by either dose tapering (gradually decreasing dose until 125 mg daily) or pulse regimen (125-500 mg daily every 2-3 days for at least 3 weeks). Child: <12 years As oral solution: 10 mg/kg 6 hourly for 10 days. ≥12 years Same as adult dose.
Severe staphylococcal or other Gram-positive infections: Dosage is individualised based on eGFR values, body weight and serum vancomycin trough levels (refer to detailed product guideline).
May be taken with or without food.
IV: Add 10 mL or 20 mL sterile water for inj to a vial labelled as containing 500 mg and 1,000 mg respectively, to make a 50 mg/mL solution. IV infusion: Further dilute the reconstituted solution containing 500 mg or 1,000 mg with at least 100 mL or 200 mL respectively of compatible IV solution.
IV: Incompatible with alkaline solutions.
Hypersensitivity to vancomycin and to other glycopeptide antibiotics (e.g. teicoplanin).
Patient with inflammatory disorders of the intestinal mucosa, underlying hearing loss or prior deafness, acute anuria, cochlear damage. Renal impairment. Children and elderly. Pregnancy and lactation.
Significant: Diarrhoea, flushing of the upper body (red man or red neck syndrome), anaphylaxis, infusion reactions (e.g. hypotension, flushing, urticaria), thrombophlebitis, extravasation, nephrotoxicity; neutropenia, bacterial superinfection (prolonged use). Rarely, ototoxicity. Blood and lymphatic system disorders: Rarely, eosinophilia. Gastrointestinal disorders: Abdominal pain, nausea, vomiting. General disorders and administration site conditions: Chills, drug fever, phlebitis, pain. Investigations: Increased serum creatinine and BUN. Musculoskeletal and connective tissue disorders: Muscle spasms of the chest and back muscles. Renal and urinary disorders: Interstitial nephritis, acute tubular necrosis. Respiratory, thoracic and mediastinal disorders: Dyspnoea, stridor. Skin and subcutaneous tissue disorders: Exanthema, mucosal inflammation, rash, pruritus. Vascular disorders: Decrease in blood pressure. Potentially Fatal: Pseudomembranous colitis, hypersensitivity reactions.
Monitor urine, LFT, renal function, and CBC periodically. Monitor serum vancomycin trough concentration 2-3 times weekly; leukocyte count regularly for prolonged use. Perform culture and susceptibility tests; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks.
Symptoms: Renal insufficiency. Management: Supportive and symptomatic treatment. Maintain glomerular filtration. Haemofiltration or haemoperfusion with polysulfone resins may be useful to reduce serum vancomycin concentration.
Increased risks of ototoxicity and nephrotoxicity with aminoglycoside, amphotericin B, bacitracin, polymyxin B, viomycin, cisplatin, loop diuretics and NSAIDs. May enhance anaesthetic-induced myocardial depression, erythema, histamine-like flushing and anaphylactoid reactions. May prolong and enhance the effects of muscle relaxants (e.g. succinylcholine, vecuronium).
Description: Vancomycin is a glycopeptide antibiotic which binds tightly to D-alanyl-D-alanine portion of cell wall precursor, blocking glycopeptide polymerisation leading to the inhibition of bacterial cell wall synthesis. It also impairs bacterial-cell-membrane permeability and RNA synthesis. Pharmacokinetics: Absorption: Poorly absorbed from the gastrointestinal tract. Time to peak plasma concentration: Immediately (IV). Distribution: Distributes widely in the body fluids (except CSF) and tissues. Crosses placenta, enters breastmilk (IV). Volume of distribution: 0.4-1 L/kg. Plasma protein binding: Approx 55%. Metabolism: Not metabolised. Excretion: IV: Via urine by glomerular filtration (approx 75%, as unchanged drug). Oral: Mainly via faeces. Elimination half-life: 4-6 hours.
Cap: Store below 25°C. Inj: Store below 25°C. Protect from light. Reconstituted solution: Store between 2-8°C.
Anon. Vancomycin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 20/06/2019.Buckingham R (ed). Vancomycin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 20/06/2019.Joint Formulary Committee. Vancomycin. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 20/06/2019.Vancomycin Capsule (Lupin Pharmaceuticals, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 20/06/2019.Vancomycin Lyophilized Powder for Solution (Fresenius Kabi, USA LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 20/06/2019.