Generic Name

Vancomycin Hydrochloride

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Classification

FDA Approved Indications

• Serious or severe bacterial infections caused by Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA)
• C difficle-associated diarrhea (oral form)

Mechanism of Action

Inhibits bacterial cell wall synthesis by binding to the D-Ala-D-Ala terminus of cell wall precursor units, leading to cell lysis and death.

Dosage and Administration

Adult: Dose varies; typically 15-20 mg/kg every 8-12 hours IV, adjusted based on renal function and severity of infection

Pediatric: Dosing based on weight and age; usually 10-15 mg/kg every 6-12 hours IV, with adjustments for renal function

Geriatric: Lower initial doses and prolonged intervals recommended due to reduced renal function

Renal Impairment: Adjust dose and interval based on renal function, monitored via serum trough levels

Hepatic Impairment: No specific adjustment required

Pharmacokinetics

Absorption: Poor oral absorption; administered IV for systemic infections, oral form (Firvanq) for C. difficile infections

Distribution: Widely distributed in body tissues and fluids, including CSF with meningeal inflammation

Metabolism: Not significantly metabolized

Excretion: Renal excretion primarily, via glomerular filtration

Half Life: Approximately 4-6 hours in patients with normal renal function

Contraindications

• Known hypersensitivity to vancomycin or related glycopeptides

Precautions

• Use cautiously in patients with renal impairment, hearing impairment, or those at risk for ototoxicity and nephrotoxicity

Adverse Reactions - Common

• Nephrotoxicity (Low (dose- and duration-dependent))
• Ototoxicity (Low (usually reversible))
• Infusion-related reactions (red man syndrome) (Moderate)

Adverse Reactions - Serious

• Anaphylaxis (Rare)
• Clostridium difficile-associated diarrhea (Rare)

Drug-Drug Interactions

• Aminoglycosides, loop diuretics—may increase risk of nephrotoxicity and ototoxicity

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Report any hearing changes, dizziness, ringing in ears
• Keep follow-up appointments for renal and auditory testing
• Complete the full course of therapy

Special Considerations

Black Box Warnings:

• Potential for nephrotoxicity, ototoxicity, and allergic reactions

Genetic Factors: None noted

Lab Test Interference: May interfere with some laboratory tests (e.g., colorimetric tests)

Overdose Management

Signs/Symptoms: Ototoxicity, nephrotoxicity, hypotension during infusion

Treatment: Discontinue drug, supportive care, and renal replacement therapy if necessary

Storage and Handling

Storage: Store at room temperature, protect from light and moisture

Stability: Stable until the expiration date provided by manufacturer