Classifications: antibiotic; glycopeptide; Therapeutic: antibiotic
Pregnancy Category: B
125 mg, 250 mg capsules; 1 g, 10 g oral powder; 500 mg, 1 g, 5 g, 10 g injection
Bactericidal action is due to inhibition of cell-wall biosynthesis and alteration of bacterial cell-membrane permeability
and ribonucleic acid (RNA) synthesis.
Active against many gram-positive organisms.
Parenterally for potentially life-threatening infections in patients allergic, nonsensitive, or resistant to other less toxic
antimicrobial drugs. Used orally only in Clostridium difficile colitis (not effective by oral route for treatment of systemic infections).
Known hypersensitivity to vancomycin, allergy to corn or corn products, previous hearing loss, concurrent or sequential
use of other ototoxic or nephrotoxic agents, IM administration.
Neonates; children; older adults; impaired kidney function, renal failure, renal impairment, concomitant administration
of aminoglycosides; hearing impairment; colitis, inflammatory disorders of the intestine; pregnancy (category B), lactation.
Route & Dosage
Adult: IV 500 mg q6h or 1 g q12h, infuse over 6090 min
Child: IV 10 mg/kg q6h, infuse over 6090 min
Neonate: IV 15 mg/kg, then 10 mg/kg/d divided q812h, infuse over 6090 min
Clostridium difficile Colitis
Adult: PO 125500 mg q6h
Child: PO 40 mg/kg/d divided q6h (max: 2 g/d)
Neonate: PO 10 mg/kg/d in divided doses
Clcr 4060 mL/min: dose q24h; <40 mL/min: extend interval based on monitoring levels
Hemodialysis: Not dialyzed
- Oral solution is prepared by adding to 10 g oral powder 115 mL of distilled water. The solution may be further diluted in
10 g of water.
PREPARE: Intermittent: Reconstitute 500 mg vial or 1 g vial with 10 mL or 20 mL, respectively, of sterile water for injection to yield 50 mg/mL. ??Further dilute each 500 mg with at least 100 mL and each 1 g with at least 200 mL of D5W, NS, or RL.
ADMINISTER: Intermittent: Give a single dose at a rate of 10 mg/min or over NOT LESS than 60 min. Avoid rapid infusion, which may cause sudden hypotension.
??Monitor IV site closely; necrosis and tissue sloughing will result from extravasation.
INCOMPATIBILITIES Solution/additive: Aminophylline, barbiturates, aztreonam (high concentration), calcium chloride, chloramphenicol, chlorothiazide, dexamethasone, erythromycin, heparin, methicillin, sodium bicarbonate, warfarin. Y-site: Albumin, amphotericin B cholesteryl, aztreonam, bivalirudin, cefazolin, cefepime, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, foscarnet, gatifloxacin, heparin, idarubicin, nafcillin, omeprazole, piperacillin/tazobactam, sargramostim, ticarcillin, ticarcillin/clavulanate, warfarin.
- Store oral and parenteral solutions in refrigerator for up to 14 d; after further dilution, parenteral solution is stable
24 h at room temperature.
Adverse Effects (≥1%)Special Senses:
Ototoxicity (auditory portion of eighth cranial nerve). Urogenital: Nephrotoxicity leading to uremia. Body as a Whole:
Hypersensitivity reactions (chills, fever, skin rash, urticaria, shock-like state
), anaphylactoid reaction with vascular collapse,
superinfections, severe pain, thrombophlebitis at injection site, generalized tingling following rapid IV
Transient leukopenia, eosinophilia. GI:
Nausea, warmth. Other:
Injection reaction that includes hypotension accompanied by flushing and erythematous rash on face and upper body
("red-neck syndrome") following rapid IV
Adds to toxicity of ototoxic
and nephrotoxic drugs
, amphotericin B, colistin, capreomycin; cidofovir; cisplatin; cyclosporine; foscarnet; ganciclovir; IV pentamidine; polymyxin B; streptozocin; tacrolimus
). Cholestyramine, colestipol
can decrease absorption of oral vancomycin; may increase risk of lactic acidosis with metformin.
Not absorbed. Peak:
30 min after end of infusion. Distribution:
Diffuses into pleural, ascitic, pericardial, and synovial fluids; small amount penetrates CSF if meninges are inflamed; crosses
8090% of IV
dose excreted in urine within 24 h; PO dose excreted in feces. Half-Life:
Assessment & Drug Effects
- Monitor BP and heart rate continuously through period of drug administration.
- Lab tests: Monitor urinalysis, kidney & liver functions, and hematologic studies periodically. Monitor serial tests of vancomycin
blood levels (peak and trough) in patients with borderline kidney function, in infants and neonates, and in patients >60
- Assess hearing. Drug may cause damage to auditory branch (not vestibular branch) of eighth cranial nerve, with consequent
deafness, which may be permanent.
- Be aware that serum levels of 6080 mcg/mL are associated with ototoxicity. Tinnitus and high-tone hearing loss may
precede deafness, which may progress even after drug is withdrawn. Older adults and those on high doses are especially susceptible.
- Monitor I&O: Report changes in I&O ratio and pattern. Oliguria or cloudy or pink urine may be a sign of nephrotoxicity (also
manifested by transient elevations in BUN, albumin, and hyaline and granular casts in urine).
Patient & Family Education
- Notify physician promptly of ringing in ears.
- Adhere to drug regimen (i.e., do not increase, decrease, or interrupt dosage. The full course of prescribed drug therapy
must be completed).