Vancomycin
General
- Type: Glycopeptides
- Dosage Forms:
- IV
- PO: Mix IV form with 30mL water
- PR: Mix IV form with 100mL NS
- Common Trade Names: Vancocin
Adult Dosing
Loading Doses
- 15-20mg/kg IV loading dose[1]
- Sample Loading Dose Table (individual ED guidelines may differ)
- >40kg: 750mg IV
- 40-59kg: 1000mg IV
- 60-90kg: 1500mg IV
- >90kg: 2000mg IV
- Alternative loading dose for serious infections: 20-25mg/kg IV
- Loading doses of 30mg/kg has shown improved target trough levels at 12 hrs with no difference in nephrotoxicity[2][3]
- Adjust maintenance dose based on serum levels
Maintenance
All: Adjust repeat doses based on serum levels
- <50kg: 500mg IV q12h
- 50-69kg: 750mg IV q12h
- >70kg: 1000mg IV q12h
- Alternative (All Weights): 10-15mg/kg IV q12
- Adjust dose based on serum levels
Clostridium Difficile
- 1st occurrence
- Uncomplicated: 125mg PO q6h x 10-14 days
- Complicated: 500mg PO/NG q6h
- May use in combo with metronidazole IV
- Consider adding vancomycin 500mg PR q6 if complete ileus
- 2nd occurrence
- Uncomplicated: 125mg PO q6h x 10-14 days
- Complicated: 500mg PO/NG q6h
- May use in combo with metronidazole IV
- Consider adding vancomycin 500mg PR q6 if complete ileus
- 3rd+ occurrence
- 125mg PO q6h x 10-14 days, then daily x 7 days, then q2-3 days x 2-8 wk
Staphylococcal Enterocolitis
- 500-2000mg/day PO divided q6-8h x 7-10 days
- First Dose: 500mg PO x 1
Pediatric Dosing
All: Adjust repeat doses based on serum levels
General (<7 Days Old)
- <1.2kg
- 15mg/kg IV q24h
- First Dose: 15mg/kg IV x 1
- 1.2-2kg
- 10-15mg/kg IV q12-18h
- First Dose: 10-15mg/kg IV x 1
- >2.1kg
- 10-15mg/kg IV q8-12h
- First Dose: 10-15mg/kg IV x 1
General (7 Days - 1 Month Old)
- <1.2kg
- 15mg/kg IV q24h
- First Dose: 15mg/kg IV x 1
- 1.2-2kg
- 10-15mg/kg IV q8-12h
- First Dose: 10-15mg/kg IV x 1
- >2.1kg
- 15-20mg/kg IV q8
- First Dose: 15-20mg/kg IV x 1
General (1 Month - 11 Years)
- 10-15mg/kg IV q6-8h
- First Dose: 10-15mg/kg IV x 1
- Max: 1 gram per dose
General (12 - 16 Years)
- 1000mg IV q12h
- First Dose: 1000mg IV x 1
- Alt: 10-15mg/kg IV q12
- Info: Repeat dosing may require up to 1200-1500mg IV q12h or 10mg/kg IV q8
Clostridium Difficile
- 40mg/kg/day PO divided q6-8h x 7-10 days
- First Dose: 10-13mg/kg x 1
- Max 500mg/dose, 2000mg/day
- For severe infection or recurrence
- May use in combination with metronidazole PO
Staphylococcal Enterocolitis
- 40mg/kg/day PO divided q6-8h x 7-10 days
- First Dose: 10-13mg/kg x 1
- Max 500mg/dose, 2000mg/day
Community-Acquired Pneumonia
- 40mg/kg/day PO divided q6-8h x 10-14 days
- First Dose: 10-13mg/kg x 1
- Info: Switch to appropriate oral regiment when possible
Special Populations
- Drug ratings in pregnancy: C
- Lactation: Probably safe
- Renal Dosing
- Adult
- CrCl 50-90: 15mg/kg x1, then usual dose q12-24h
- CrCl 10-50: 15mg/kg x1, then usual dose q24h-96h
- CrCl <10: 15mg/kg x1, then usual dose q4-7 days
- Hemodialysis: Give supplement only if high-flux dialyzer used
- Peritoneal dialysis: No supplement
- Pediatric
- CrCl 10-50: give q18-48h
- CrCl <10: give q48-96h
- Hemodialysis: Give supplement only if high-flux dialyzer used
- Peritoneal dialysis: No supplement
- Adult
- Hepatic Dosing (Adult & Pediatric)
- Not defined
Contraindications
- Allergy to class/drug
Adverse Reactions
Serious
- Anaphylaxis
- Severe hypotension (rapid IV use) - not much evidence but consider anti-histamine[4]:
- 1.25-1.67mg/kg/dose diphenhydramine IV to pediatric patients
- 25 - 50mg diphenhydramine IV to adults
- Thrombophlebitis
- Tissue necrosis (if extravasation)
- vasculitis
- Exfoliative dermatitis
- Stevens-Johnson Syndrome
- Toxic Epidermal Necrolysis
- Drug rash with eosinophilia and systemic symptoms
- Interstitial nephritis
- Nephrotoxicity
- Ototoxicity
- Neutropenia
- Thrombocytopenia
- Superinfection
- Clostridium difficile
Pharmacology
- Half-life: 4-6h (7.5 days ESRD)
- Metabolism: CYP450
- Excretion:
- IV route: Urine
- PO Route: Minimal systemic absorption unless intestinal inflammation or renal impairment
- Mechanism of Action
- Bactericidal against S. aureus and pneumococci
- Bacteriostatic against enterococci[5]
Antibiotic Sensitivities[6]
Key
- S susceptible/sensitive (usually)
- I intermediate (variably susceptible/resistant)
- R resistant (or not effective clinically)
- S+ synergistic with cell wall antibiotics
- U sensitive for UTI only (non systemic infection)
- X1 no data
- X2 active in vitro, but not used clinically
- X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
- X4 active in vitro, but not clinically effective for strep pneumonia
See Also
References
- Ryback M, et al. Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm. 2009; 66(1):82-98.
- Rosini JM, et al. A randomized trial of loading vancomycin in the emergency department. Ann Pharmacother. 2015; 49(1):6-13.
- Rosini JM, et al. High single-dose vancomycin loading is not associated with increased nephrotoxicity in emergency department sepsis patients. Acad Emerg Med. 2016 Feb 6.
- Lyon GD and Bruce DL. Diphenhydramine reversal of vancomycin-induced hypotension. Anesth Analg. 1988 Nov;67(11):1109-10.
- Bactericidal agents in the treatment of MRSA infections—the potential role of daptomycin. J. Antimicrob. Chemother. (2006) 58 (6): 1107-1117.
- Sanford Guide to Antimicrobial Therapy 2014
This article is issued from
Wikem.
The text is licensed under Creative
Commons - Attribution - Sharealike.
Additional terms may apply for the media files.