Overview
Vancomycin is a glycopeptide antibiotic used primarily for serious infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and other susceptible gram-positive bacteria. It is often reserved for patients with penicillin allergies or when other antibiotics have failed. The drug requires careful dosing and monitoring due to potential nephrotoxicity and ototoxicity.
Mechanism of Action
Vancomycin inhibits bacterial cell wall synthesis by binding to the D-alanyl-D-alanine terminus of cell wall precursor units, preventing cross-linking and leading to cell lysis. It is bactericidal against most susceptible organisms.
Indications
- Treatment of serious infections caused by methicillin-resistant staphylococci (MRSA)
- Penicillin-allergic patients with susceptible infections
- Staphylococcal endocarditis, septicemia, bone infections, lower respiratory tract infections, and skin/skin structure infections
- Endocarditis caused by Streptococcus viridans or S. bovis (alone or with aminoglycosides)
- Endocarditis caused by enterococci (only in combination with aminoglycosides)
- Diphtheroid endocarditis
- Prosthetic valve endocarditis caused by S. epidermidis or diphtheroids (in combination with rifampin/aminoglycosides)
- Oral administration for Clostridium difficile-associated pseudomembranous colitis and staphylococcal enterocolitis
Common Doses
- 500 mg vial
- 1 g vial
- 5 g vial
- 10 g vial
Dosage
Administer as diluted IV infusion over at least 60 minutes to avoid rapid-infusion reactions. Recommended concentration ≤5 mg/mL (up to 10 mg/mL in fluid-restricted patients) and rate ≤10 mg/min in adults. Dosage must be adjusted based on renal function, age, and infection severity.
Contraindications
- Known hypersensitivity to vancomycin
Side Effects
- Infusion-related reactions (red man syndrome: flushing, erythema, pruritus, hypotension)
- Ototoxicity (tinnitus, hearing loss)
- Nephrotoxicity (increased serum creatinine)
- Thrombophlebitis at injection site
- Neutropenia
- Anaphylactoid reactions
- Drug fever
- Rash
Interactions
- Concomitant use with anesthetic agents may increase risk of erythema and anaphylactoid reactions
- Concurrent use with other nephrotoxic/neurotoxic drugs (aminoglycosides, amphotericin B, cisplatin) requires careful monitoring due to additive toxicity
Counseling Points
- Complete full course of therapy even if symptoms improve
- Report any hearing changes, ringing in ears, or dizziness immediately
- Stay well-hydrated unless instructed otherwise
- Inform all healthcare providers about vancomycin use
- Report severe diarrhea, abdominal pain, or blood in stool
- Understand importance of slow IV infusion to prevent reactions