Antimicrobials
Vancomycin IV

Vancomycin IV

Low
None
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General Information

  • Continued empiric use for presumed infection with negative cultures.
  • Treatment of a single-positive blood culture for coagulase-negative staphylococci.
  • Routine surgical prophylaxis except as above.
  • Empiric treatment for first fever in neutropenic patients without evidence of catheterrelated bloodstream infection (e.g. inflamed IV catheter site), severe mucositis, or history of MRSA.
  • Prophylaxis for infection or colonization of indwelling intravascular or intracranial catheters.
  • Selective decontamination of the digestive tract.
  • Eradication of MRSA colonization.
  • Routine prophylaxis for patients on continuous ambulatory peritoneal dialysis or hemodialysis.
  • When chosen only for convenience of dosing for treatment of infections caused by betalactam susceptible organisms in patients who are HD-dependent.
  • Topical application or irrigation.

Suspected or proven MRSA, coagulase-negative Staphylococcal infections, Enterococcal infections

Laboratory

  • Collect trough 30 min before 4th dose if abnormal/fluctuating renal function.
  • Target trough 10-15 mcg/mL for most serious infections, 15-20 mcg/mL for meningitis or osteomyelitis
  • If trough low, increase dose (do not exceed 2g/dose) OR decrease dosing interval.
  • If trough >20, increase dosing interval or decrease dose
  • Recommend dose per pharmacy
  • Cr baseline and weekly (for potential dose adjustment and nephrotoxicity assessment)
  • CBC weekly

Clinical

  • Phlebitis
  • Hypersensitivity
  • GI effects
  • Ototoxicity
  • Vancomycin Flushing Syndrome
  • Nephrotoxicity (usually in combination with other nephrotoxins)
  • Phlebitis
  • Reversible neutropenia

Aminoglycosides may potentiate nephrotoxicity

May enhance neuromuscular blockade of NM blocking agents

Careful with concomitant nephrotoxins

Target levels vary widely based on site of infection. Consult Infectious Disease or Pharmacy for assistance

ID Consult is strongly advised for proven or suspected MRSA infections and for all S aureus bloodstream infections

Antimicrobial class: Glycopeptide

Pregnancy category: C

Average serum half life: 8 hours

Biliary penetration: Moderate

CSF penetration: Moderate

Lung penetration: Therapeutic

Urine penetration: Therapeutic