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

All: Adjust repeat doses based on serum levels

General

• <50kg: 500mg IV q12h
• 50-69kg: 750mg IV q12h
• >70kg: 1000mg IV q12h
• Alternative (All Weights): 10-15 mg/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

• 500-2000 mg/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
  • 15 mg/kg IV q24h
  • First Dose: 15 mg/kg IV x 1
• 1.2-2kg
  • 10-15 mg/kg IV q12-18h
  • First Dose: 10-15 mg/kg IV x 1
• >2.1kg
  • 10-15 mg/kg IV q8-12h
  • First Dose: 10-15 mg/kg IV x 1

General (7 Days - 1 Month Old)

• <1.2kg
  • 15 mg/kg IV q24h
  • First Dose: 15 mg/kg IV x 1
• 1.2-2kg
  • 10-15 mg/kg IV q8-12h
  • First Dose: 10-15 mg/kg IV x 1
• >2.1kg
  • 15-20 mg/kg IV q8
  • First Dose: 15-20 mg/kg IV x 1

General (1 Month - 11 Years)

• 10-15 mg/kg IV q6-8h
• First Dose: 10-15 mg/kg IV x 1
• Max: 1 gram per dose

General (12 - 16 Years)

• 1000 mg IV q12h
• First Dose: 1000mg IV x 1
• Alt: 10-15 mg/kg IV q12
• Info: Repeat dosing may require up to 1200-1500mg IV q12h or 10 mg/kg IV q8

Clostridium Difficile

• 40 mg/kg/day PO divided q6-8h x 7-10 days
• First Dose: 10-13 mg/kg x 1
• Max 500mg/dose, 2000mg/day
• For severe infection or recurrence
• May use in combination with metronidazole PO

Staphylococcal Enterocolitis

• 40 mg/kg/day PO divided q6-8h x 7-10 days
• First Dose: 10-13 mg/kg x 1
• Max 500mg/dose, 2000mg/day

Community-Acquired Pneumonia

• 40 mg/kg/day PO divided q6-8h x 10-14 days
• First Dose: 10-13 mg/kg x 1
• Info: Switch to appropriate oral regiment when possible

Special Populations

• 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
• Hepatic Dosing (Adult & Pediatric)
  • Not defined

Contraindications

• Allergy to class/drug

Adverse Reactions

Serious

• Anaphylaxis
• Severe hypotension (rapid IV use)
• 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

Common

• Red Man Syndrome (rapid IV use)
• Hypotension (rapid IV use)
• Fever
• Nausea
• rigors
• Eosinophilia
• Rash
• Urticaria
• Phlebitis
• Tinnitus
• Dizziness/Vertigo
• Elevated BUN/Creatinine
• Vomiting (PO use)
• Flatulence (PO use)

Pharmacology

• Half-life:
• Metabolism:
• Excretion:
• Mechanism of Action:

See Also

• Antibiotics (Main)

Source

• Epocrates