Vancomycin IV

C. diff Risk

None

Oral Bioavailability

NA

Approximate Cost

General Information

Common Usage

Suspected or proven MRSA, coagulase-negative Staphylococcal infections, Enterococcal infections.

Drug Monitoring

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.

Adverse Effects

  •  Nephrotoxicity

  •  Cytopenias

  •  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).

Major Interactions

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.

Additional Information

Pharmacists may adjust vancomycin dosing and order serum levels and creatinine for monitoring purposes.

Pharmacology

Antimicrobial class: Glycopeptide

Pregnancy category: C

Average serum half life: 8 hours

Biliary penetration: Moderate

CSF penetration: Moderate

Lung penetration: Therapeutic

Urine penetration: Therapeutic