⚠️ 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)
| Indication | Dose | Frequency | Route |
|---|
| Systemic infection | 15–20 mg/kg (max 2 g per dose). Severe: Loading 25–30 mg/kg. | 8–12 hrly | IV (adjust per plasma levels) |
| C. difficile (first / recurrence) | 125 mg | 6-hourly | PO for 10–14 days |
| Severe C. difficile | 500 mg | 6-hourly | PO/NG ± rectal, with IV metronidazole |
📦 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
