Antimicrobials
Vancomycin IV

Vancomycin IV

Low
None

Dosing

General Information

Serious infections due to beta-lactam resistant, Gram-positive microorganisms such as:

  • Methicillin resistant Staphylococcus aureus (MRSA)
  • Ampicillin resistant Enterococcus spp.
  • Methicillin resistant coagulase-negative staphylococci
  • Ceftriaxone resistant S. pneumoniae (meningitis)

Infections due to Gram-positive microorganisms in patients with a history of severe delayed skin reactions/organ dysfunction to beta-lactam antimicrobials. For example:

  • Stevens-Johnson syndrome (SJS)
  • Toxic epidermal necrolysis (TEN)
  • Drug rash with eosinophilia & systemic symptoms (DRESS)

Surgical prophylaxis Vancomycin should be reserved for the following:

  • Patients with a history of anaphylaxis to ceFAZolin
  • Patients with a history of severe delayed skin reaction/organ dysfunction to any beta-lactam antimicrobial. For example, SJS, TEN, DRESS.
  • Refer to Beta-lactam allergy guideline for more information.
  • Nephrotoxicity
  • Cytopenias (esp. neutropenia, thrombocytopenia)
  • Ototoxicity (controversial)
  • Histamine-release (vancomyin infusion reaction) or flushing can result from rapid infusion rates and is not a true allergy. Refer to the IV manual for recommended minimum administration time
  • Aminoglycosides may potentiate nephrotoxicity.
  • May enhance neuromuscular blockade of NM blocking agents.
  • Careful with concomitant nephrotoxins.

Special Considerations:

  • Oral vancomycin administration is suitable only for C. difficile infection, as it is not absorbed beyond the GI tract. Do not use oral vancomycin as step-down therapy for IV vancomycin.
  • Vancomycin is a less effective choice than a beta-lactam antimicrobial for methicillin-susceptible staphylococcal infections
  • Staphylococcus aureus with an MIC of greater than or equal to 2 mg/L have a high failure rate; consider an ID consult

Antimicrobial class: Glycopeptide

Pregnancy category: C

Average serum half life: 8 hours

Urine penetration: Therapeutic

Lung penetration: Therapeutic

CSF penetration: Moderate

Biliary penetration: Moderate