Suspected or proven MRSA, coagulase-negative Staphylococcal infections, Enterococcal infections.
Collect trough levels at least 30 minutes before 4th dose at steady-state conditions in patients with normal renal function.
Serum trough concentrations should always be maintained above 10 mg/L to avoid development of resistance.
Collecting serum peak concentrations is no longer recommended.
Target serum trough concentration range:
15 to 20 mg/L for most serious infections (bacteremia, endocarditis, osteomyelitis, meningitis, and hospital-acquired pneumonia caused by S. aureus)
10 to 15 mg/L for uncomplicated infections
Higher serum trough concentrations of 20 to 25 mg/L may be targeted for some serious, aggressive, life-threatening infections. Discuss indication specific target trough range with ID/Pharmacy.
If trough low, increase dose (do not exceed 2 g/dose) OR decrease dosing interval (younger patients may require more frequent dosing due to more rapid clearance).
If trough greater than 20 mg/L, may consider holding a dose if appropriate, and assess to increase dosing interval OR decrease dose.
Rash including Stevens-Johnson Syndrome
Red Man Syndrome (histamine release- slow down infusion)
Ototoxicity is rarely associated with monotherapy; has been reported in patients receiving excessive doses, those who have underlying hearing loss, or those receiving concomitant ototoxic drugs (eg. aminoglycosides).
Aminoglycosides may potentiate nephrotoxicity.
May enhance neuromuscular blockade of NM blocking agents.
Use cautiously with concomitant nephrotoxins.
Piperacillin may enhance the nephrotoxic effect of vancomycin.
Pharmacists may adjust vancomycin dosing and order serum levels and creatinine for monitoring purposes.
Antimicrobial class: Glycopeptide
Pregnancy category: C
Average serum half life: 8 hours
Biliary penetration: Moderate
CSF penetration: Moderate
Lung penetration: Therapeutic
Urine penetration: Therapeutic