Vancomycin is a potent glycopeptide antibiotic primarily used for serious gram-positive infections, including MRSA and C. difficile. Its unique mechanism makes it a last-line defense against resistant organisms when other antibiotics fail.
This antibiotic inhibits bacterial cell wall synthesis by binding to D-alanyl-D-alanine precursors. It's bactericidal against most gram-positive organisms but ineffective against gram-negative bacteria due to its large molecular size.
Vancomycin comes as IV solutions for systemic infections and oral capsules for C. difficile colitis. The IV form requires careful dose calculation based on weight and renal function.
Nephrotoxicity and ototoxicity are major concerns. Red man syndrome (flushing/rash) occurs with rapid infusion. Regular monitoring of drug levels and renal function is essential.
Emerging resistance (VRE, VRSA) threatens vancomycin's effectiveness. Strict antimicrobial stewardship helps preserve its utility for serious infections.
IV solutions remain stable for 14 days refrigerated or 7 days at room temperature. Oral capsules should be stored at controlled room temperature.
Compared to beta-lactams, vancomycin has narrower gram-positive coverage but is essential for MRSA. Newer alternatives (daptomycin, linezolid) may be preferred in some cases.
Severe hypersensitivity reactions prohibit use. Caution required in renal impairment, hearing loss, or concurrent nephrotoxic medications.
Pregnancy category C - risk versus benefit assessment required. Neonatal dosing requires adjustment based on gestational age and weight.
Increased risk of nephrotoxicity with aminoglycosides, amphotericin B, or IV contrast. Anesthetics may enhance flushing reactions.
IV infusion must be given slowly (over at least 60 minutes) to prevent red man syndrome. Oral form is not absorbed systemically.
Trough levels are checked before 4th dose (target 10-20 mcg/mL for most infections). Peak levels are rarely needed today.
Vancomycin treats serious MRSA infections, coagulase-negative staphylococci, and C. difficile colitis. It's used for endocarditis, osteomyelitis, and device-related infections when resistant organisms are suspected.
Therapeutic drug monitoring ensures efficacy while minimizing toxicity. Trough levels below 10 mcg/mL may lead to treatment failure, while high levels increase nephrotoxicity risk.
A histamine-mediated reaction causing flushing, rash, and hypotension during rapid infusion. Slowing the infusion rate and premedication with antihistamines can prevent this.
Yes, nephrotoxicity occurs in 5-25% of patients, especially with prolonged use or concurrent nephrotoxins. Regular creatinine monitoring is mandatory during treatment.
Oral vancomycin isn't absorbed systemically - it stays in the gut to treat C. difficile. IV vancomycin achieves systemic distribution but doesn't penetrate the gut lumen well.
Hearing changes, decreased urine output, or severe skin reactions. These may indicate serious toxicity requiring dose adjustment or discontinuation.
Never skip scheduled blood tests - they're crucial for safe vancomycin use.
Duration varies from 7-10 days for simple infections to 6+ weeks for endocarditis or osteomyelitis. C. difficile treatment typically lasts 10-14 days.
Its large molecule size prevents penetration into gram-negative bacteria. Overuse would also accelerate resistance development in gram-positive organisms.
Yes, outpatient IV therapy is possible with proper training and monitoring. Some patients receive once-daily dosing after loading.
VRE (vancomycin-resistant Enterococcus) is more common. VRSA (vancomycin-resistant S. aureus) is rare but extremely concerning for public health.
For C. difficile, the capsule is dissolved in water and drunk. It's critical to complete the full course even if symptoms improve earlier.
No significant interactions with contraceptives are documented. However, diarrhea from C. difficile treatment could reduce oral contraceptive absorption.
Always inform all healthcare providers you're taking vancomycin before procedures.