Vancomycin hydrochloride
Vancomycin hydrochloride (Vancocin)
Vancomycin hydrochloride
(van-koh- MY-sin)
Pregnancy Category: C, (B for capsules only) Vancocin Vancoled (Rx)

Classification: Antibiotic, miscellaneous

See Also: See also Anti-Infectives .

Action/Kinetics: Appears to bind to bacterial cell wall, arresting its synthesis and lysing the cytoplasmic membrane by a mechanism that is different from that of penicillins and cephalosporins. May also change the permeability of the cytoplasmic membranes of bacteria, thus inhibiting RNA synthesis. Bactericidal for most organisms and bacteriostatic for enterococci. Poorly absorbed from the GI tract. Diffuses in pleural, pericardial, ascitic, and synovial fluids after parenteral administration. Peak plasma levels, IV: 33 mcg/mL 5 min after 0.5-g dosage. t 1/2, after PO: 4-8 hr for adults and 2-3 hr for children; t 1/2, after IV: 4-11 hr for adults and ranging from 2-3 hr in children to 6-10 hr for newborns. The half-life is increased markedly in the presence of renal impairment (240 hr has been noted). Primarily excreted in urine unchanged. Auditory and renal function tests are indicated before and during therapy.

Uses: PO: Antibiotic-induced pseudomembranous colitis due to Clostridium difficile. Staphylococcal enterocolitis. Severe or progressive antibiotic-induced diarrhea caused by C. difficile that is not responsive to the causative antibiotic being discontinued; also for debilitated clients.
IV: Severe staphylococcal infections in clients who have not responded to penicillins or cephalosporins, who cannot receive these drugs, or who have resistant infections. Infections include lower respiratory tract infections, bone infections, endocarditis, septicemia, and skin and skin structure infections. Alone or in combination with aminoglycosides to treat endocarditis caused by Streptococcus viridans or S. bovis. Must combine with an aminoglycoside to treat endocarditis due to Streptococcus faecalis. Used with rifampin, an aminoglycoside (or both) to treat early onset prosthetic valve endocarditis caused by Staphylococcus epidermidis or other diphtheroids. Prophylaxis of bacterial endocarditis in pencillin-allergic clients who have congenital heart disease or rheumatic or other acquired or valvular heart disease if such clients are undergoing dental or surgical procedures of the upper respiratory tract. The parenteral dosage form may be given PO to treat pseudomembranous colitis or staphylococcal enterocolitis due to C. difficile.

Contraindications: Hypersensitivity. Minor infections. Lactation.

Special Concerns: Use with extreme caution in the presence of impaired renal function or previous hearing loss. Geriatric clients are at a greater risk of developing ototoxicity.

Side Effects: Ototoxicity (may lead to deafness; deafness may progress after drug is discontinued), nephrotoxicity (may lead to uremia). Red-neck syndrome: Sudden and profound drop in BP with or without a maculopapular rash over the face, neck, upper chest, and extremities. CV: Exaggerated hypotension (due to rapid bolus administration), including shock and possibly cardiac arrest. GU: Renal failure (rare), interstitial nephritis (rare). Respiratory: Wheezing, dyspnea. Dermatologic: Urticaria, pruritus, macular rashes, exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis vasculitis. Allergic: Drug fever, hypersensitivity, anaphylaxis. At injection site: Tissue irritation, including pain, tenderness, necrosis, thrombophlebitis. Miscellaneous: Nausea, chills, tinnitus, eosinophilia, neutropenia (reversible), pseudomembranous colitis.

Drug Interactions: Aminoglycosides / Risk of nephrotoxicity Anesthetics / Risk of erythema and histamine-like flushing in children Muscle relaxants, nondepolarizing / Neuromuscular blockade

How Supplied: Capsule: 125 mg, 250 mg; Powder for injection: 500 mg, 1 g, 5 g, 10 g; Powder for reconstitution: 250 mg/5 mL, 500 mg/6 mL

Dosage
?Capsules, Oral Solution
Adults: 0.5-2 g/day in three to four divided doses for 7-10 days. Alternatively, 125 mg t.i.d.-q.i.d. for C. difficile may be as effective as the 500-mg dosage. Children: 40 mg/kg/day in three to four divided doses for 7-10 days, not to exceed 2 g/day. Neonates: 10 mg/kg/day in divided doses.
?IV Severe staphylococcal infections.
Adults: 500 mg q 6 hr or 1 g q 12 hr. Children: 10 mg/kg/6 hr. Infants and neonates, initial: 15 mg/kg for one dose; then, 10 mg/kg q 12 hr for neonates in the first week of life and q 8 hr thereafter up to 1 month of age.
Prophylaxis of bacterial endocarditis in dental, oral, or upper respiratory tract procedures in penicillin-allergic clients.
Adults: 1 g vancomycin over 1 hr plus 1.5 mg/kg gentamicin (IV or IM), not to exceed 80 mg, 1 hr before the procedure. May repeat once, 8 hr after the initial dose. Children: 20 mg/kg vancomycin plus 2 mg/kg gentamicin (IV or IM), not to exceed 80 mg, 1 hr before the procedure. May repeat once, 8 hr after the initial dose.