Known brand names include Vancocin.
A glycopeptide antibiotic given IV for serious gram-positive infections such as MRSA bloodstream, heart valve, bone, skin, and lung infections. Taken by mouth, it stays in the gut and treats C. difficile diarrhea. Kidney function, hearing, and blood levels need watching.
Labeled use. Oral only; IV vancomycin is not effective.
Labeled use. IV, for bone infections from MRSA or other susceptible staphylococci.
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Labeled use. IV, for septicemia from MRSA or other susceptible staphylococci.
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Labeled use. IV, from MRSA or other susceptible staphylococci.
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Labeled use. IV, from MRSA or other susceptible staphylococci.
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Labeled use. IV, including MRSA, streptococcal, and enterococcal endocarditis (with an aminoglycoside).
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IV vancomycin is a mainstay for serious MRSA infections and for gram-positive infections in patients with severe beta-lactam allergy; it kills methicillin-susceptible S. aureus more slowly and less reliably than an antistaphylococcal beta-lactam, so switch when cultures allow. It has no gram-negative coverage. Oral vancomycin (or fidaxomicin) is a first choice for C. difficile infection; IV vancomycin does not reach the colon. Current practice favors AUC-guided dosing over trough-only monitoring.
Bactericidal. It mainly blocks bacterial cell wall synthesis, and it also changes cell membrane permeability and RNA synthesis. It is not active against gram-negative bacilli, mycobacteria, or fungi. It is poorly absorbed by mouth, so oral doses act only in the gut, and IV doses are needed for systemic infections.
Narrow therapeutic index. The label directs measuring trough serum vancomycin levels to guide IV dosing, especially when kidney function is changing.
Doses come from the FDA label. Study tool, not for clinical decisions.
Required. Give an initial IV dose of at least 15 mg/kg in any degree of renal impairment, then adjust using trough levels, especially in seriously ill patients with changing renal function. Functionally anephric: 15 mg/kg, then 1.9 mg/kg every 24 hours.
No antidote. Give supportive care and protect kidney function. Standard dialysis removes little vancomycin; hemofiltration and hemoperfusion with polysulfone resin have increased clearance.
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No data on birth defect or miscarriage risk. Published data from the second and third trimesters show no link to adverse pregnancy outcomes, and animal studies showed no harm. Oral doses are poorly absorbed.
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Present in breast milk after IV use, at unknown levels. Oral absorption is low. No data on effects on the breastfed infant; weigh benefits of breastfeeding against maternal need.
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IV, 1 month and older: 10 mg/kg every 6 hours, each over at least 60 minutes. Neonates: 15 mg/kg first, then 10 mg/kg every 12 hours in the first week of life and every 8 hours after that until 1 month. Oral for C. difficile or staphylococcal enterocolitis: 40 mg/kg per day in 3 or 4 doses for 7 to 10 days, not over 2 g per day. Monitor levels and renal function; infusion reactions can be more severe in children.
Higher risk of kidney injury, including with oral use; check renal function during and after therapy in patients over 65, even with normal baseline function. Older adults may respond more slowly, so avoid stopping or switching too early. Choose doses carefully given reduced renal clearance.
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