Makindo Medical Notes

⚠️ Pre-dose (trough) concentration should be 10–15 mg/L (or 15–20 mg/L for severe infections). 💉 Infuse slowly to avoid “Red Man Syndrome” – usually occurs if 1 g is given in <2 hrs. 🚫 Infusion rate must not exceed 10 mg/min. 📌 Maximum daily dose: 4 g.

📖 About

Always check the BNF link here.

• 💊 Glycopeptide antibiotic (related to teicoplanin).
• 🦠 Effective against Gram-positive aerobes and anaerobes, including MRSA (though resistant strains reported).
• 💧 Eliminated almost entirely by glomerular filtration (>90%).
• 📌 Renal function is the key determinant of dose and frequency.

⚙️ Action

• 🔗 Inhibits cell wall synthesis in Gram-positive bacteria.
• 🧪 Blocks incorporation of peptidoglycan precursors (NAM/NAG).
• 💊 Poorly absorbed orally – systemic infections require IV.

Vancomycin is widely used for prophylaxis, empirical, and targeted therapy. It remains central in treating multi-resistant Staphylococcus aureus.

💉 Indications

• 🧠 Pseudomembranous colitis (oral only).
• ❤️ Infective endocarditis due to Gram-positive cocci.
• 💉 MRSA and other resistant staphylococcal infections.
• 🩺 Catheter-related bloodstream infections.

📊 Dosing (check BNF / datasheet)

📦 Administration

• IV administration may be via intermittent infusion or (in Critical Care/Neurosurgery) continuous infusion.
• ⚖️ Loading dose based on actual body weight (if CrCl >10 ml/min, not in children <16y or dialysis patients):
  • <60 kg → 1 g in 250 ml NaCl 0.9% over 2 hr
  • 60–90 kg → 1.5 g in 500 ml NaCl 0.9% over 3 hr
  • >90 kg → 2 g in 500 ml NaCl 0.9% over 4 hr

🧪 Monitoring (Intermittent dosing)

• 🎯 Pre-dose (trough) target: 15–20 mg/L (severe infections); some centres accept 10–15 mg/L.
• 📌 Check trough just before 4th dose, then adjust accordingly.
• 👵 Monitor renal function daily in elderly/frail patients.
• ⏱️ Do not delay doses while awaiting results unless severe renal impairment or oliguria (<0.5 ml/kg/hr).

⚖️ Maintenance dosing by creatinine clearance (CrCl)

• <10 → Avoid; consult Microbiology.
• 10–19 → 500 mg IV over 1 hr, 48 hr post-load.
• 20–29 → 500 mg IV over 1 hr, 24 hr post-load.
• 30–39 → 750 mg IV over 2 hr, 24 hr post-load.
• 40–54 → 500 mg IV over 1 hr, 12 hrly.
• 55–74 → 750 mg IV over 2 hr, 12 hrly.
• 75–89 → 1 g IV over 2 hr, 12 hrly.
• 90–110 → 1.25 g IV over 3 hr, 12 hrly.
• >110 → 1.5 g IV over 3 hr, 12 hrly.

📉 Dose adjustments

• <10 mg/L → ↑ dose by 50% (round to nearest 250 mg). If >1.5 g BD, seek Micro advice.
• 10–15 mg/L → Maintain dose; check renal function daily, trough twice weekly.
• >15–20 mg/L → Hold until <15 mg/L, seek Micro advice, check daily.

🔄 Interactions

• 👂 Ototoxic drugs (e.g. gentamicin, furosemide).
• 💊 Nephrotoxicity risk ↑ with ciclosporin, aminoglycosides.

⚠️ Cautions

• 🩺 Nephrotoxic and ototoxic → monitor closely.
• ⏱️ Avoid rapid infusion → risk of anaphylactoid reaction (Red Man Syndrome).
• 👵 Elderly patients at higher risk – stop if tinnitus or hearing loss develops.

⛔ Contraindications

• 🚫 Hypersensitivity to vancomycin or other glycopeptides.

💥 Side Effects

• 💧 Nephrotoxicity, interstitial nephritis.
• 👂 Ototoxicity (tinnitus, hearing loss).
• 🩸 Haematological: neutropenia, thrombocytopenia.
• 🌡️ Hypersensitivity: Stevens–Johnson syndrome, TEN, anaphylaxis.
• ⚡ Infusion-related: hypotension, shock, wheeze, “Red Man Syndrome.”

📚 References

• Vancomycin dosing (DBTH NHS)
• Salford Royal NHS Guidance