- Discussion:
- for penicillin resistant to
staph and w/
enterococci endocarditis (in combination with
aminoglycosides);
- it is ineffective against gm neg bacterial (its large molecular weight keeps it from penetrating the outer cell membrane of gram-negative bacilli);
- oral treatment of
C. difficile induced psuedomembranous colitis;
- adult: 500mg IV q6hr or 1gm IV q12 hr for 7-10days; for colitis: 500mg PO q6hr or 1gm PO q12hr for 7 days;
- peds: 40-50 mg/kg/day q6hr (Levels: trough < 15; peak: 25-40) less than 30 days: 10-15 mg/kg q12hr;
- prophylaxis of bacterial endocarditis: 1gm IV infused slowly over 1hr before procedure (or try vanc + gentamicin 30min before procedure);
-
therapeutic range:
- serum levels: 20-40 mmg/ ml after 1.5 hr; trough:5-10 mmg/ml;
- mean peak vancomycin concentrations during steady state of concentrations during steady state of 32.6 +/- 9.3 mcg/mL in 12 premature infants (mean age
26 weeks, mean weight 770 g) with bacterial sepsis;
- levels were measured at the end of a 60-minute infusion;
- commonly added to cement for treatment of orthopaedic infections; (see
addition of antibiotics to cement)
- Cautions:
- avoid other nephrotoxic and ototoxic agents;
- must monitor serum levels and auditory function with chronic use;
- good diffusion from blood into CSF only with inflammation;
- rate of IV dosing:
- typically infused over 1 hour;
- note Red Neck syndrome with fever; this is secondary to histamine release, try slowing IV rate;
- ref: Antihistamine prophylaxis permits rapid vancomycin infusion.
- renal insufficiency:
- must reduce dosage and be used cautiously in patients with renal failure;
- 80% of drug will be excreted in to urine (w/ nl RF(x));
- it appears that plasma protein binding may decrease substantially in ESRD and that hemodialysis does not correct these changes;
- standard high efficiency hemodialysis does not significantly remove vancomycin due to the large molecular wt;
- dose for 70kg adult {gm/dosingintervalinhours} CrCl:>80: 1/12; CrCl:50-79: 1/12-24; CrCl:30-49: 1/24-36; CrCl:10-29: 1/48-72;
- w/ mild renal failure (GFR more than 50 mL/min) should receive vancomycin every 24 to 72 hours, patients with moderate renal failure (GFR 10 to 50
mL/min) should receive vancomycin every 72 to 240 hours;
- in patients with a CrCl of < 25 ml/min, give an initial single dose of 15 mg/kg and adjust dosage and interval based on serum creatinine conc;
- patients with severe renal failure (GFR less than 10 mL/min) should receive vancomycin every 240 hours;
- dosage adjustment during dialysis:
- a dose of 1.9 mg/kg/24 hr for functionally anephric patients on hemodialysis or peritoneal dialysis will result in mean steady-state serum levels of 15 mcg/mL;
- there is a small but measurable removal of vancomycin in dialysis;
- manufacturer recommends a loading dose of 15 mg/kg followed by maintenance doses of 1.9 mg/kg/24 hr in anephric patients on dialysis;
References for Vancomycin:
Vancomycin-Induced Red Man Syndrome.
Vancomycin prophylaxis and elective total joint arthroplasty.
Nephrotoxicity of vancomycin, alone and with an aminoglycoside.
Use of vancomycin and tobramycin polymethylmethacrylate impregnated beads in the management of chronic osteomyelitis.
Pharmacokinetics of vancomycin: observations in 28 patients and dosage recommendations.
Vancomycin-Induced Immune Thrombocytopenia.
Limitations of vancomycin in the management of resistant staphylococcal infections.
Vancomycin versus cefazolin prophylaxis for cardiac surgery in the setting of a high prevalence of MRSA infections.
