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Vancomycin

    Brands

    DEA Class; Rx

    Common Brand Names; Vancocin, Firvanq

    • Glycopeptides

    Glycopeptide antibiotic; only effective for gram-positive bacteria; poorly absorbed orally; however, used orally to treat GI infections such as pseudomembranous colitis; serum concentration monitoring with systemic use.

    Indicated for enterocolitis caused by Staphylococcus aureus (including methicillin-resistant strains)

    Indicated for treatment of Clostridium difficile (C. difficile)-associated diarrhea

    Indicated for treatment of infective endocarditis due to: susceptible isolates of MRSA, viridans group streptococci Streptococcus gallolyticus, Enterococcus species, and Corynebacterium species

    For enterococcal endocarditis, use in combination with an aminoglycoside

    Methicillin-susceptible staphylococci in penicillin-allergic patients, or those patients who cannot receive or who have failed to respond to other therapies

    Indicated for treatment of early-onset prosthetic valve endocarditis caused by Staphylococcus epidermidis in combination with rifampin and an aminoglycoside

    Indicated for treatment of septicemia due to: susceptible isolates of methicillin-resistant Staphylococcus aureus (MRSA) and coagulase negative staphylococci, methicillin-susceptible staphylococci in penicillin-allergic patients, or patients who cannot receive or who have failed to respond to other drugs, including penicillins or cephalosporins

    Indicated for treatment of skin and skin structure infections due to: susceptible isolates of MRSA and coagulase negative staphylococci, methicillin-susceptible staphylococci in penicillin-allergic patients, or those patients who cannot receive or have failed to respond to other therapies

    Indicated for treatment of bone infections due to: susceptible isolates of MRSA and coagulase negative staphylococci, methicillin-susceptible staphylococci in penicillin-allergic patients, or those patients who cannot receive or have failed to respond to other therapies

    Indicated for treatment of lower respiratory tract infections due to: susceptible isolates of MRSA and coagulase negative staphylococci, methicillin-susceptible staphylococci in penicillin-allergic patients, or those patients who cannot receive or have failed to respond to other therapies

    Prophylaxis of infection in cardiac, thoracic, and arterial procedures; craniotomy; joint replacement; amputation

    Hypersensitivity

    • Nausea (17%)
    • Abdominal pain (15%)
    • Hypokalemia (13%)
    • Vomiting (9%)
    • Diarrhea (9%)
    • Pyrexia (9%)
    • Flatulence (8%)
    • Urinary tract infection (8%)
    • Headache (7%)
    • Peripheral edema (6%)
    • Back pain (6%)
    • Fatigue (5%)
    • Nephrotoxicity (5%)

    Rapid IV administration may result in flushing, pruritus, hypotension, erythema, and urticaria

    Systemic vancomycin exposure may result in acute kidney injury (AKI) and interstitial nephritis; risk of AKI increases as systemic exposure increases; additional risk factors for AKI include concomitant use of nephrotoxic drugs, patients with pre-existing renal impairment, or with comorbidities that predispose to renal impairment

    Endocarditis prophylaxis: Use only for high-risk patients, per AHA guidelines

    Ototoxicity may occur; toxicity proportional to amount of drug given and duration of treatment; presence of tinnitus or vertigo may indicate vestibular injury; discontinue if signs of ototoxicity occur

    Risk of neutropenia increases with doses >25 g (reversible following discontinuation of therapy)

    Avoid extravasation; necrosis may occur

    Prolonged use may result in fungal or bacterial superinfection

    Use caution in patients with renal impairment; monitor trough concentrations if multiple oral doses administered

    Hemorrhagic occlusive retinal vasculitis, including permanent loss of vision, occurred in patients receiving intracameral or intravitreal administration of vancomycin during or after cataract surgery; safety and efficacy of vancomycin administered by intracameral or intravitreal route not established by adequate and well-controlled trials; vancomycin not indicated for prophylaxis of endophthalmitis

    Oral vancomycin only indicated for treatment of pseudomembranous colitis due to Clostridioides difficile (C. difficile) and enterocolitis due to S. aureus; not effective for systemic infections

    Unknown whether vancomycin can affect reproduction capacity

    In a controlled clinical study, potential ototoxic and nephrotoxic effects of vancomycin on infants were evaluated when administered to pregnant women for serious staphylococcal infections complicating IV drug abuse

    Vancomycin is excreted in human milk

    Adults

    2 g/day IV/PO per FDA-approved labeling; individualize IV dosage to patient age, weight, indication for use, and serum drug concentration monitoring.

    Geriatric

    2 g/day IV/PO per FDA-approved labeling; individualize IV dosage to patient age, weight, indication for use, and serum drug concentration monitoring.

    Adolescents

    40 mg/kg/day IV and 2 g/day PO per FDA-approved product labeling; however, initial doses up to 60 mg/kg/day IV are recommended off-label for severe infections. Individualize IV dosage to patient age, weight, indication for use, and serum drug concentration monitoring.

    Children

    40 mg/kg/day IV and 2 g/day PO per FDA-approved product labeling; however, initial doses up to 60 mg/kg/day IV are recommended off-label for severe infections. Individualize IV dosage to patient age, weight, indication for use, and serum drug concentration monitoring.

    Infants

    40 mg/kg/day IV/PO per FDA-approved product labeling; however, initial doses up to 60 mg/kg/day IV are recommended off-label for severe infections. Individualize IV dosage to patient age, weight, indication for use, and serum drug concentration monitoring.

    Neonates

    8 days and older: 30 mg/kg/day IV per FDA-approved product labeling; however, doses should be individualized based on patient age, weight, indication for use, and serum drug concentration monitoring.
    0 to 7 days: 20 mg/kg/day IV per FDA-approved product labeling; however, doses should be individualized based on patient age, weight, indication for use, and serum drug concentration monitoring.

    vancomycin hydrochloride

    capsule (Vancocin)

    • 125mg
    • 250mg

    injection, lyophilized powder for reconstitution (generic)

    • 500mg
    • 750mg
    • 1g
    • 5g
    • 10g

    kit, powder for oral solution (Firvanq)

    • 3.75g
    • 7.5g
    • 10.5g
    • 15g

    injection, single-dose flexible bag (generic)

    • 500mg/100mL
    • 750mg/150mL
    • 1g/200mL
    • 1.25g/250mL
    • 1.5g/300mL
    • 1.75g/350mL
    • 2g/400mL