Vancomycin IV

C difficile risk
Oral Bioavailability


Defined criteria for use and/or important safety considerations. See below for more information.

General Information

  • Nephrotoxicity: more likely if trough levels persistently 15-20 mg/L
  • Cytopenias especially neutropenia and thrombocytopenia
  • Ototoxicity with prolonged use
  • Histamine-release causes a vancomycin flushing reaction

  • 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 stepdown 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

Biliary penetration: Moderate

CSF penetration: Moderate

Lung penetration: Therapeutic

Urine penetration: Therapeutic

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