Vancomycin

Class: Glycopeptide Antibiotic

Mechanism of Action: Inhibits bacterial cell wall synthesis by binding to D-alanyl-D-alanine terminus of cell wall precursors, preventing peptidoglycan polymerization. Active mainly against Gram-positive bacteria.

Indications

• Serious infections caused by MRSA
• Endocarditis due to Gram-positive cocci
• Sepsis from Gram-positive bacteria
• Osteomyelitis and joint infections
• Clostridioides difficile infection (oral route)
• Skin and soft tissue infections

Dosage

• Adults: 15–20 mg/kg IV every 8–12 hours (adjusted based on renal function and trough levels)
• Children: 10–15 mg/kg IV every 6–8 hours
• Oral for C. difficile: 125–500 mg every 6 hours

Maximum Dose

Typically guided by renal function and serum levels; generally 2 g/day in adults (IV).

Major Side Effects

• Nephrotoxicity (especially with high doses or concomitant nephrotoxic drugs)
• Ototoxicity (rare, high doses)
• Red man syndrome (flushing, rash, hypotension with rapid infusion)
• Thrombophlebitis at IV site
• Neutropenia or thrombocytopenia (prolonged therapy)

Contraindications

• Hypersensitivity to vancomycin
• Caution in patients with pre-existing renal impairment

Compatible Fluids

• 0.9% Sodium Chloride
• 5% Dextrose

Route of Administration

• Intravenous infusion
• Oral (for gastrointestinal infections only)

Type of Administration

• IV: infusion over 60–120 minutes (do not push rapidly)
• Oral: for C. difficile infections, swallowed without crushing

Special Precautions

• Monitor renal function and vancomycin trough levels during therapy
• Infuse slowly to prevent red man syndrome
• Adjust dose in renal impairment
• Monitor complete blood count for prolonged therapy
• Use caution with other nephrotoxic or ototoxic drugs