Section Links

Vancomycin

cell wall synthesis inhibitor; bacteriocidal glycopeptide

Uses

works on gram positive bacteria
severe or life-threatening staphylococcal infections in patients who cannot receive or have failed to respond to penicillins or cephalosporins
- endocarditis
- osteomyelitis
- pneumonia
- septicemia
- soft-tissue infections
- enterocolitis
possible role prophylactically
antibiotic-associated pseudomembranous colitis caused by C. difficle

Mechanism

bind to D-ala in nascent cell wall peptides, preventing cross-linking during peptidoglycan formation

Dose and Half Life

for most infections, parenteral administration of vancomycin is preferred over oral administration
for staphylococcal enterocolitis and C. difficle pseudomembranous colitis, oral administration is required.
a normal IV dose is 500 mg every 6 hours
an adult oral dose is 125-500 mg orally every 6-8 hours for 7-10 days
patients with impaired renal function require serum levels dosage adjustment

Side Effects

short term

exaggerated hypotension, including shock and occasionally cardiac arrest, can occur following rapid bolus administration
toxic serum levels can occur when given IV

long term

has been ototoxic in a small number of patients, most of whom had poor kidney function
nephrotoxicity has been rarely reported in patients given large doses, most of whom had pre-exidting kidney dysfunction or who were given aminoglycosides concomitantly

Counter-Indications

in patients known to have antibiotic hypersensitivity
can cross placental barrier, but risk to fetus is unknown. use in pregnant women only if clearly needed

Metabolism and Excretion

excreted rapidly through kidney; decreased renal clearance can cause levels to rise rapidly
careful monitoring of vancomycin levels is required when used along with neurotoxic and nephrotoxic agents

Dependency