Vancomycin


Thông tin thuốc gốc
Chỉ định và Liều dùng
Intravenous
Complicated skin and soft tissue infections
Adult: 15-20 mg/kg 8-12 hourly via slow infusion of at least 60 minutes or at Max rate of 10 mg/min (whichever is longer). Max: 2,000 mg/dose. Seriously ill patients: Initially, 25-30 mg/kg to facilitate rapid attainment of the target trough serum vancomycin concentration. Adjust dose according to plasma concentration monitoring. Treatment duration: 7-14 days (non-necrotising); 4-6 weeks (necrotising). Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Child: Term and pre-term neonates' dosage are based on post-menstrual age in weeks, refer to detailed product guidelines. 1 month to <12 years 10-15 mg/kg 6 hourly via slow infusion of at least 60 minutes or at Max rate of 10 mg/min (whichever is longer). ≥12 years Same as adult dose. Treatment duration: 7-14 days (non-necrotising); 4-6 weeks (necrotising). Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).

Intravenous
Bone and joint infections, Infective endocarditis
Adult: 15-20 mg/kg 8-12 hourly for 4-6 weeks via slow infusion of at least 60 minutes or at Max rate of 10 mg/min (whichever is longer). Max: 2,000 mg/dose. Seriously ill patients: Initially, 25-30 mg/kg to facilitate rapid attainment of the target trough serum vancomycin concentration. Adjust dose according to plasma concentration monitoring. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Child: Term and pre-term neonates' dosage are based on post-menstrual age in weeks, refer to detailed product guidelines. 1 month to <12 years 10-15 mg/kg 6 hourly for 4-6 weeks via slow infusion of at least 60 minutes or at Max rate of 10 mg/min (whichever is longer). ≥12 years Same as adult dose. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).

Intravenous
Community-acquired pneumonia, Hospital-acquired pneumonia, Ventilator associated pneumonia
Adult: 15-20 mg/kg 8-12 hourly for 7-14 days via slow infusion of at least 60 minutes or at Max rate of 10 mg/min (whichever is longer). Seriously ill patients: Initially, 25-30 mg/kg to facilitate rapid achievement of the target trough serum concentration. Adjust dose according to plasma concentration monitoring. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Child: Term and pre-term neonates' dosage are based on post-menstrual age in weeks, refer to detailed product guidelines. 1 month to <12 years 10-15 mg/kg 6 hourly for 7-14 days via slow infusion of at least 60 minutes or at Max rate of 10 mg/min (whichever is longer). ≥12 years Same as adult dose. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).

Intravenous
Prophylaxis of endocarditis
Adult: In patients at high risk of developing bacterial endocarditis when undergoing major surgery: Initially, 15 mg/kg prior to induction of anaesthesia; may repeat dosage depending on the duration of surgery.

Oral
Staphylococcal enterocolitis
Adult: 500-2,000 mg in 3-4 divided doses for 7-10 days. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Child: 40 mg/kg in 3-4 divided doses for 7-10 days. Max: 2,000 mg daily. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).

Oral
Clostridioides difficile infection
Adult: 125 mg 6 hourly for 10 days for the 1st episode of non-severe infection; may increase to 500 mg 6 hourly for 10 days for severe or complicated infection. 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 treatment (125-500 mg every 2-3 days for at least 3 weeks). Dosage recommendations may vary among countries and individual products (refer to specific product guidelines).
Child: <12 years As oral solution: 10 mg/kg 6 hourly for 10 days. Max: 2,000 mg daily. ≥12 years Same as adult dose. Dosage recommendations may vary among countries and individual products (refer to specific product guidelines).
Suy thận
Intravenous
Complicated skin and soft tissue infections; Bone and joint infections; Infective endocarditis; Community-acquired pneumonia; Hospital-acquired pneumonia; Ventilator associated pneumonia:
Dosage is individualised based on eGFR values, body weight and serum vancomycin trough levels (refer to detailed product guideline). Maintain initial dose (25-30 mg/kg) for seriously ill patients.
Cách dùng
May be taken with or without food.
Hướng dẫn pha thuốc
Oral solution: Using the reconstituted powder for inj (50 mg/mL), extract the appropriate volume for the dose and add 30 mL of water or the diluent provided. Solution for infusion: Reconstitute vials labelled as 500 mg and 1,000 mg with 10 mL and 20 mL of sterile water for inj respectively, to make a 50 mg/mL solution. Further dilute the reconstituted solution with a compatible IV solution to a concentration of 5 mg/mL (10 mg/mL in fluid restriction). Refer to specific product guidelines for further instructions on reconstitution.
Tương kỵ
Incompatible with alkaline solutions. May form precipitates with β-lactam antibiotics.
Chống chỉ định
Hypersensitivity.
Thận trọng
Patient with inflammatory disorders of the intestinal mucosa or Clostridioides difficile-induced pseudomembranous colitis, underlying hearing loss; anuria, allergic reactions to teicoplanin. Oral vancomycin is only indicated for specific types of infection; recommendations may vary among countries, refer to country-specific guidelines. Avoid rapid infusion; use in patients with previous hearing loss. Renal impairment. Children and elderly. Pregnancy and lactation.
Tác dụng không mong muốn
Significant: Fungal or bacterial superinfection (prolonged use); transient or permanent ototoxicity, deafness preceded by tinnitus; nephrotoxicity (reversible), may lead to acute renal failure; infusion-related reactions (e.g. hypotension, "red man syndrome", urticaria, pruritus); extravasation (may occur with necrosis), thrombophlebitis; Clostridioides difficile associated diarrhoea (IV).
Blood and lymphatic system disorders: Neutropenia (reversible), thrombocytopenia.
Gastrointestinal disorders: Nausea; abdominal pain, diarrhoea, flatulence, vomiting (oral).
General disorders and administration site conditions: Fever, chills, fatigue; peripheral oedema (oral).
Metabolism and nutrition disorders: Hypokalaemia (oral).
Musculoskeletal and connective tissue disorders: Muscle spasm (chest and back), back pain.
Nervous system disorders: Headache.
Renal and urinary disorders: UTI. Rarely, interstitial nephritis.
Respiratory, thoracic and mediastinal disorders: Dyspnoea, stridor.
Vascular disorders: Decrease in blood pressure; vasculitis.
Potentially Fatal: Hypersensitivity reactions, severe cutaneous adverse reactions including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), acute generalised exanthematous pustulosis (AGEP), linear IgA bullous dermatosis (LABD); Clostridioides difficile colitis (IV).
IV/Parenteral: C; Gastroenteral/PO: B
Chỉ số theo dõi
Perform culture and susceptibility tests; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks. Monitor CBC, LFT, urine, and serum trough vancomycin concentration periodically. Serial monitoring of renal function and auditory function should be performed. Monitor for signs and symptoms of skin reactions.
Quá liều
Oral: Symptoms: Nausea, vomiting, epigastric discomfort, diarrhoea, and renal insufficiency. Management: Symptomatic and supportive treatment. Perform gastric lavage and administer charcoal in repeated doses. Ensure adequate diuresis. Maintain glomerular filtration.
Tương tác
Increased frequency of erythema, histamine-like flushing, and anaphylactic reactions with anaesthetic agents. May enhance anaesthetic-induced myocardial depression. May reduce the efficacy of oral contraceptives. Concomitant use with other potentially ototoxic, neurotoxic, or nephrotoxic drugs (e.g. aminoglycosides, amphotericin B, polymyxin B, bacitracin, colistin, piperacillin/tazobactam, cisplatin, loop diuretics, NSAIDs) may potentiate the toxicity of vancomycin. Bile acid sequestrants (e.g. colestyramine) may diminish the therapeutic effect of oral vancomycin; administer several hours apart. May enhance the neuromuscular-blocking effect of neuromuscular-blocking agents (e.g. suxamethonium, vecuronium).
Potentially Fatal: May increase the risk of anaphylactic shock with teicoplanin.
Tác dụng
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: IV: Immediately (after completion of infusion).
Distribution: Distributes widely in the body fluids (except CSF) and tissues. Crosses the placenta and enters breast milk. Volume of distribution: 0.4-1 L/kg. Plasma protein binding: Approx 55%.
Metabolism: No apparent metabolism.
Excretion: IV: Via urine (75% as unchanged drug). Oral: Mainly via faeces. Elimination half-life: 4-6 hours.
Đặc tính

Chemical Structure Image
Vancomycin

Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 14969, Vancomycin. https://pubchem.ncbi.nlm.nih.gov/compound/Vancomycin. Accessed Sept. 26, 2022.

Bảo quản
Cap and intact vials: Store between 15-25°C. Oral solution kit: Store between 2-8°C. Protect from light. Reconstituted oral solution and solution for infusion: Store between 2-8°C; refer to specific product guidelines for the duration of storage. Do not freeze.
Phân loại MIMS
Các loại kháng sinh khác
Phân loại ATC
J01XA01 - vancomycin ; Belongs to the class of glycopeptide antibacterials. Used in the systemic treatment of infections.
Tài liệu tham khảo
Anon. Vancomycin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 06/07/2022.

Buckingham R (ed). Vancomycin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/07/2022.

Firvanq (Azurity Pharmaceuticals, Inc). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 06/07/2022.

Joint Formulary Committee. Vancomycin. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/07/2022.

Mersa 500 mg Lyophilized Powder for I.V. Infusion (The Cathay Drug Co., Inc.). MIMS Philippines. http://www.mims.com/philippines. Accessed 06/07/2022.

Mylan New Zealand Ltd. Vancomycin 500 mg and 1000 mg Powder for Infusion data sheet 19 June 2019. Medsafe. http://www.medsafe.govt.nz. Accessed 06/07/2022.

Vancocin 500 mg Powder for Solution for Infusion and Oral Solution; Vancocin 1000 mg Powder for Solution for Infusion and Oral Solution (Flynn Pharma Ltd). MHRA. https://products.mhra.gov.uk. Accessed 06/07/2022.

Vancomycin 1 g Powder for Solution for Infusion (Wockhardt UK Limited). MHRA. https://products.mhra.gov.uk. Accessed 06/07/2022.

Vancomycin Capsules 125 mg (Xellia Pharmaceuticals ApS). MHRA. https://products.mhra.gov.uk. Accessed 06/07/2022.

Vancomycin Hydrochloride Capsule (Orient Pharma Co., Ltd Yunlin Plant). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 06/07/2022.

Vancomycin Hydrochloride Injection, Powder, Lyophilized, for Solution (Hikma Pharmaceuticals USA Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 06/07/2022.

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