Antimicrobials
Vancomycin PO

Vancomycin PO

C difficile risk
N/A
Oral Bioavailability
None
Cost
$$

Dosing

Non Severe to Severe CDIFulminant CDIIntra-colonic doseTapering Regimen (started after 10-14 days of usual dosing or as indicated by ID consult)Secondary Prevention (for high risk patients needing antibiotics for another indication)125 mg PO q6h x 10-14 days500 mg PO q6h x 14 days (may also require IV metronidazole and subsequent vancomycin taper, consult ID and see full treatment guideline for details)500 mg in 100 mL of NS q6h by rectal retention enema. Retain each enema for as long as possible

Typically reserved for severe, complicated episodes with paralytic ileus. Refer to *C. difficile treatment guidelines for specific dosing recommendations*Vancomycin 125mg PO q6h x 14 days, then Vancomycin 125mg PO q12h x 7 days, then Vancomycin 125mg PO q24h x 7 days, then Vancomycin 125mg PO every 2 or 3 days for 2-8 weeks125 mg PO q12h for duration of antibiotic (may consider continuing for 1 week after completion of antibiotic course)

Oral/rectal vancomycin is ineffective for treating systemic infections.

General Information

Only indication is in the treatment of C. difficile infection.

  • Possibility of accumulation in severe renal dysfunction

  • Oral/rectal therapy:

    • Serum sample monitoring not typically required
    • Some systemic absorption of enteral vancomycin may occur in patients with renal failure who have mucosal disruption from colitis
    • Monitoring serum vancomycin levels may be considered for these patients with renal failure who have severe colitis and require a prolonged course of enteral vancomycin

Bile acid sequestrants may diminish the therapeutic effects of vancomycin

  • Avoid concurrent administration when possible

  • If use of both agents is necessary, separate doses by at least 2 hours to minimize significant interaction

No systemic absorption.

May increase vancomycin resistant Enterococci colonization in the gut.

LU Code for outpatient use.

  • LU 557: initial episode, mild, no response or intolerance to metronidazole (up to 56 caps)

  • LU 558: initial episdoe, moderate-severe, uncomplicated (up to 56 caps)

  • LU 559: first recurrence, mild-moderate-severe, uncomplicated (up to 56 caps)

  • LU 560: second or subsequent recurrence, mild-moderate-severe, uncomplicated (up to 114 caps)

Antimicrobial class: Glycopeptide

Pregnancy category: B

Average serum half life: 0 hours

Biliary penetration: None

CSF penetration: None

Lung penetration: None

Urine penetration: None