Vancomycin

What is Vancomycin

Vancomycin is a parenteral glycopeptide antibiotic and is structurally related to teicoplanin, an investigational agent.

Vancomycin is obtained from Nocardia orientalis and is effective only for gram-positive bacteria. Although it is poorly absorbed after oral administration, vancomycin is occasionally administered orally to treat GI infections such as pseudomembranous colitis due to overgrowth of Clostridium difficile.

Vancomycin has been used clinically since 1956, but recent improvements in manufacturing have increased its purity and reduced its toxicity. Vancomycin was initially approved for use by the FDA in 1964.

Indications

  1. Actinomyces sp.
  2. anthrax
  3. Bacillus sp.
  4. bacteremia
  5. bone and joint infections
  6. brain abscess
  7. cellulitis
  8. Clostridium difficile
  9. Clostridium sp.
  10. community-acquired pneumonia
  11. Corynebacterium jeikeium
  12. Corynebacterium sp.
  13. endocarditis
  14. Enterococcus faecalis
  15. Enterococcus faecium
  16. Enterococcus sp.
  17. enterocolitis
  18. febrile neutropenia
  19. infectious arthritis
  20. Lactobacillus sp.
  21. Listeria monocytogenes
  22. lower respiratory tract infections
  23. mastitis
  24. meningitis
  25. neonatal mastitis
  26. nosocomial pneumonia
  27. orthopedic device-related infection
  28. osteomyelitis
  29. perinatal Group B streptococcal infection prophylaxis
  30. peritonitis
  31. pleural empyema
  32. pneumonia
  33. pseudomembranous colitis
  34. sepsis
  35. skin and skin structure infections
  36. Staphylococcus aureus (MRSA)
  37. Staphylococcus aureus (MSSA)
  38. Staphylococcus epidermidis
  39. Staphylococcus sp.
  40. Streptococcus agalactiae (group B streptococci)
  41. Streptococcus bovis
  42. Streptococcus pneumoniae
  43. Streptococcus pyogenes (group A beta-hemolytic streptococci)
  44. subdural empyema
  45. surgical infection prophylaxis
  46. vancomycin desensitization
  47. ventriculitis
  48. Viridans streptococci

Side Effects

  1. abdominal pain
  2. acute generalized exanthematous pustulosis (AGEP)
  3. agranulocytosis
  4. anaphylactoid reactions
  5. anemia
  6. azotemia
  7. back pain
  8. cardiac arrest
  9. chills
  10. constipation
  11. depression
  12. diarrhea
  13. dizziness
  14. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
  15. dyspnea
  16. eosinophilia
  17. erythema
  18. exfoliative dermatitis
  19. fatigue
  20. fever
  21. flatulence
  22. flushing
  23. headache
  24. hearing loss
  25. hemorrhagic occlusive retinal vasculitis
  26. hypokalemia
  27. hypotension
  28. infection
  29. injection site reaction
  30. insomnia
  31. interstitial nephritis
  32. nausea
  33. neutropenia
  34. paresthesias
  35. peripheral edema
  36. phlebitis
  37. pruritus
  38. pseudomembranous colitis
  39. rash
  40. red man syndrome
  41. renal failure (unspecified)
  42. sinus tachycardia
  43. Stevens-Johnson syndrome
  44. superinfection
  45. thrombocytopenia
  46. tinnitus
  47. toxic epidermal necrolysis
  48. urticaria
  49. vasculitis
  50. vertigo
  51. visual impairment
  52. vomiting
  53. wheezing

Monitoring Parameters

  • audiometry
  • serum creatinine/BUN
  • serum vancomycin concentrations

Contraindications

  • breast-feeding
  • colitis
  • corn hypersensitivity
  • diarrhea
  • extravasation
  • geriatric
  • GI disease
  • hearing impairment
  • heart failure
  • inflammatory bowel disease
  • infusion-related reactions
  • intracameral administration
  • intramuscular administration
  • intrathecal administration
  • intravitreal administration
  • neonates
  • nephrotoxicity
  • ototoxicity
  • pregnancy
  • premature neonates
  • pseudomembranous colitis
  • renal disease
  • renal failure
  • renal impairment
  • sodium restriction
  • tinnitus
  • ulcerative colitis
  • vancomycin hypersensitivity
  • viral infection

Interactions

  • Acyclovir
  • Adefovir
  • Aldesleukin, IL-2
  • Alfentanil
  • Amikacin
  • Aminoglycosides
  • Amlodipine; Celecoxib
  • Amphotericin B
  • Amphotericin B cholesteryl sulfate complex (ABCD)
  • Amphotericin B lipid complex (ABLC)
  • Amphotericin B liposomal (LAmB)
  • Aprotinin
  • Atracurium
  • Azelastine; Fluticasone
  • Bacitracin
  • Beclomethasone
  • Benzonatate
  • Beractant
  • Betamethasone
  • Bleomycin
  • Budesonide
  • Budesonide; Formoterol
  • Calfactant
  • Capreomycin
  • Celecoxib
  • Cholestyramine
  • Ciclesonide
  • Cidofovir
  • Cisatracurium
  • Cisplatin
  • Colesevelam
  • Colestipol
  • Colistimethate, Colistin, Polymyxin E
  • Corticosteroids
  • Corticotropin, ACTH
  • Cortisone
  • Cyclosporine
  • Deferasirox
  • Deflazacort
  • Dexamethasone
  • Diclofenac
  • Diclofenac; Misoprostol
  • Dienogest; Estradiol valerate
  • Diflunisal
  • Diphenhydramine; Ibuprofen
  • Diphenhydramine; Naproxen
  • Donepezil; Memantine
  • Doravirine; Lamivudine; Tenofovir disoproxil fumarate
  • Doxacurium
  • Drospirenone
  • Drospirenone; Estradiol
  • Drospirenone; Ethinyl Estradiol
  • Drospirenone; Ethinyl Estradiol; Levomefolate
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Elagolix; Estradiol; Norethindrone acetate
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
  • Emtricitabine; Tenofovir disoproxil fumarate
  • Entecavir
  • Esomeprazole; Naproxen
  • Estradiol; Levonorgestrel
  • Estradiol; Norethindrone
  • Estradiol; Norgestimate
  • Ethacrynic Acid
  • Ethinyl Estradiol
  • Ethinyl Estradiol; Desogestrel
  • Ethinyl Estradiol; Ethynodiol Diacetate
  • Ethinyl Estradiol; Etonogestrel
  • Ethinyl Estradiol; Levonorgestrel
  • Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
  • Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
  • Ethinyl Estradiol; Norelgestromin
  • Ethinyl Estradiol; Norethindrone
  • Ethinyl Estradiol; Norethindrone Acetate
  • Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
  • Ethinyl Estradiol; Norethindrone; Ferrous fumarate
  • Ethinyl Estradiol; Norgestimate
  • Ethinyl Estradiol; Norgestrel
  • Etodolac
  • Famotidine; Ibuprofen
  • Fenoprofen
  • Fentanyl
  • Fludrocortisone
  • Flunisolide
  • Flurbiprofen
  • Fluticasone
  • Fluticasone; Salmeterol
  • Fluticasone; Umeclidinium; Vilanterol
  • Fluticasone; Vilanterol
  • Formoterol; Mometasone
  • Foscarnet
  • Furosemide
  • Gallium
  • Gallium Ga 68 Dotatate
  • Ganciclovir
  • General anesthetics
  • Gentamicin
  • Gold
  • Hyaluronidase, Recombinant; Immune Globulin
  • Hydrocodone; Ibuprofen
  • Hydrocortisone
  • Ibandronate
  • Ibuprofen
  • Ibuprofen; Oxycodone
  • Ibuprofen; Pseudoephedrine
  • Immune Globulin IV, IVIG, IGIV
  • Indomethacin
  • Inotersen
  • Kanamycin
  • Ketoprofen
  • Ketorolac
  • Lamivudine; Tenofovir Disoproxil Fumarate
  • Lansoprazole; Naproxen
  • Leuprolide; Norethindrone
  • Levonorgestrel
  • Lithium
  • Lorazepam
  • Mannitol
  • Meclofenamate Sodium
  • Mefenamic Acid
  • Meloxicam
  • Memantine
  • Mestranol; Norethindrone
  • Methohexital
  • Methotrexate
  • Methylprednisolone
  • Mivacurium
  • Mometasone
  • Nabumetone
  • Naproxen
  • Naproxen; Pseudoephedrine
  • Naproxen; Sumatriptan
  • Neuromuscular blockers
  • Nonsteroidal antiinflammatory drugs
  • Norethindrone
  • Norgestrel
  • Oral Contraceptives
  • Oxaliplatin
  • Oxaprozin
  • Pamidronate
  • Pancuronium
  • Paromomycin
  • Pentamidine
  • Piperacillin
  • Piperacillin; Tazobactam
  • Piroxicam
  • Plazomicin
  • Polymyxin B
  • Polymyxins
  • Poractant Alfa
  • Prednisolone
  • Prednisone
  • Rapacuronium
  • Remifentanil
  • Rocuronium
  • Rofecoxib
  • Salicylates
  • Segesterone Acetate; Ethinyl Estradiol
  • Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
  • Streptomycin
  • Streptozocin
  • Succinylcholine
  • Sufentanil
  • Sulindac
  • Tacrolimus
  • Telbivudine
  • Tenofovir Alafenamide
  • Tenofovir, PMPA
  • Thiopental
  • Tobramycin
  • Tolmetin
  • Tolvaptan
  • Triamcinolone
  • Trospium
  • Tubocurarine
  • Valacyclovir
  • Valdecoxib
  • Valganciclovir
  • Vecuronium
  • Warfarin
  • Zoledronic Acid
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