vancomycin
Brand: Vancocin
(van-koe-mye'sin)
Pharmacological Action
Inhibits bacterial cell wall synthesis, blocks glycopeptides
Therapeutic outcome: Bactericidal for the following organisms: staphylococci, streptococci, Corynebacterium, Clostridium
Uses
Actinomyces sp., Bacillus sp., Clostridium difficile, Clostridium sp., Enterococcus faecalis, Enterococcus faecium, Enterococcus sp., Lactobacillus sp., Listeria monocytogenes, Staphylococcus aureus (MRSA), Staphylococcus aureus (MSSA), Staphylococcus epidermidis, Staphylococcus sp., Streptococcus agalactiae (group B streptococci), Streptococcus bovis, Streptococcus pneumoniae, Streptococcus pyogenes (group A beta-hemolytic streptococci), Viridans streptococci; may be effective against Corynebacterium jeikeium, Corynebacterium sp.; pseudomembranous colitis, staphylococcal enterocolitis, group A b-hemolytic streptococci, endocarditis prophylaxis for dental procedures, bacteremia, join/bone infections, osteomyelitis, pneumonia, septicemia
Contraindications
Hypersensitivity, previous hearing loss
Precautions: Pregnancy B (PO); C (IV), breastfeeding, neonates, geriatric, renal disease
Dosage & Routes
Serious staphylococcal infections
Adult: IV 500 mg (7.5 mg/kg) q6-8 hr or 1 g (15 mg/kg) q12 hr
Child: IV 40-60 mg/kg/day divided q6-8 hr
Neonate: IV 15 mg/kg initially followed by 10 mg/kg q8-24 hr Pseudomembranous/staphylococcal enterocolitis
Adult: PO 125 mg qid × 10-14 days
Child: PO (unlabeled) 40 mg/kg/day divided q6 hr × 7-10 days, max 2 g/day Endocarditis prophylaxis for dental procedure
Adult: IV 2 g divided
Child: IV 20 mg/kg over 1 hr; 1 hr before procedure Renal dose
Adult: IV 15-20 mg/kg loading dose in seriously ill; individualize all other doses
Available forms: Cap 125, 250 mg; powder for inj IV 500, 750 mg; vials 1, 5, 10 g; dextrose sol for inj 500 mg/100 ml, 750 mg/150 ml, 1 g/200 ml
Implementation - Give antihistamine if red man syndrome occurs: decreased B/P, flushing of neck, face; stop or slow infusion - Give dose based on serum conc - Give in equal intervals around the clock to maintain blood levels - Store at room temp for up to 2 wk after reconstitution - Have adrenaline, suction, tracheostomy set, endotracheal intubation equipment on unit; anaphylaxis may occur - Provide adequate intake of fluids (2 L) to prevent nephrotoxicity PO route - Give without regard to food, swallow whole Intermittent IV INF route - Give after reconstitution with 10 ml of sterile water for inj (500 mg/10 ml); further dilution is needed for IV, 500 mg/100 ml of 0.9% NaCl, D5 W given as intermittent inf over 1 hr; decrease rate of inf if red man syndrome occurs Continuous IV INF route (unlabeled) - Reconstitute, then may inf 1-2 g in volume to give over 24 hr if intermittent IV route cannot be used
Y-site compatibilities: Acetylcysteine, acyclovir, alatrofloxacin, aldesleukin, alemtuzumab, alfentanil, allopurinol, alprostadil, amifostine, amikacin, amino acids injection, aminocaproic acid, amiodarone, amoxicillin-clavulanate, amsacrine, anidulafungin, argatroban, ascorbic acid injection, atenolol, atracurium, atropine, azithromycin, benztropine, bleomycin, bretylium, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, carmustine, caspofungin, cefpirome, chlorproMAZINE, cimetidine, ciprofloxacin, cisatracurium, CISplatin, clarithromycin, clindamycin, codeine, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAUNOrubicin liposome, dexamethasone, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, dolasetron, DOPamine, doripenem, doxacurium, doxapram, DOXOrubicin, DOXOrubicin liposomal, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentaNYL, filgrastim, fluconazole, fludarabine, folic acid (as sodium salt), gallium, gemcitabine, gentamicin, glycopyrrolate, granisetron, HYDROmorphone, hydrOXYzine, ifosfamide, insulin, regular, irinotecan, isoproterenol, isosorbide, ketamine, labetalol, lactated Ringer’s injection, lepirudin, levofloxacin, lidocaine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, meropenem, metaraminol, methyldopate, metoclopramide, metoprolol, metroNIDAZOLE, midazolam, milrinone, minocycline, mitoXANtrone, morphine, multiple vitamins injection, mycophenolate, nalbuphine, naloxone, nesiritide, netilmicin, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ofloxacin, ondansetron, oxacillin, oxaliplatin, oxytocin, PACLitaxel (solvent/surfactant), palonosetron, pamidronate, pancuronium, papaverine, PEMEtrexed, penicillin G potassium/sodium, pentamidine, pentazocine, PENTobarbital, perphenazine, PHENobarbital, phentolamine, phenylephrine, phytonadione, piritramide, polymyxin B, potassium acetate/chloride, procainamide, prochlorperazine, promethazine, propranolol, protamine, pyridoxine, quiNIDine, ranitidine, remifentanil, rifampin, Ringer’s injection, riTUXimab, sodium acetate/bicarbonate/citrate, succinylcholine, SUFentanil, tacrolimus, teniposide, thiamine, thiotepa, tigecycline, tirofiban, TNA (3-in-1), tobramycin, tolazoline, TPN (2-in-1), trastuzumab, urapidil, vasopressin, vecuronium, verapamil, vinBLAStine, vinCRIStine, vinorelbine, voriconazole, zidovudine, zoledronic acid
Additive compatibilities: Amikacin, atracurium, calcium gluconate, cefepime, cimetidine, corticotropin, dimenhyDRINATE, hydrocortisone, meropenem, ofloxacin, potassium chloride, ranitidine, verapamil, vit B/C
Adverse Effects
CNS: Headache
CV: Cardiac arrest, vascular collapse (rare), hypotension, peripheral edema
EENT: Ototoxicity, permanent deafness, tinnitus, nystagmus
GI: Nausea, pseudomembranous colitis
GU:
Nephrotoxicity: increased BUN, creatinine, albumin, fatal uremia
HEMA: Leukopenia, eosinophilia, neutropenia
INTEG: Chills, fever, rash, thrombophlebitis at inj site, urticaria, pruritus, necrosis (red man syndrome), skin/subcutaneous tissue disorders
MS: Back pain
RESP: Wheezing, dyspnea
SYST: Anaphylaxis, superinfection
Pharmacokinetics
Absorption: Poorly absorbed (PO), completely absorbed (IV)
Distribution: Widely distributed, crosses placenta
Metabolism: Liver
Excretion: PO, feces; IV, kidneys
Half-life: 4-8 hr
Pharmacodynamics
IV: Onset Immediate, Peak Inf end, Duration Unknown
Interactions
Individual drugs Acyclovir, adefovir, amphotericin B, capreomycin, CISplatin, colistin, cycloSPORINE, foscarnet, ganciclovir, methotrexate, pamidronate, IV pentamidine, polymyxin B, streptozocin, tacrolimus, zoledronic acid: increased ototoxicity or nephrotoxicity Cholestyramine, colestipol, cidofovir: do not use concurrently
MetFORMIN: increased lactic acidosis
Drug classifications Aminoglycosides, cephalosporins,
NSAIDs: increased ototoxicity or nephrotoxicity Nodepolarizing muscle relaxants: increased neuromuscular effects
Drug/lab test
Increased: BUN/creatinine, eosinophils
Decreased: WBC
Nursing Considerations
Assessment - Assess for infection: WBC, urine, stools, sputum, wound characteristics, throughout treatment - Monitor • I&O ratio, BUN, creatinine; report hematuria, oliguria because nephrotoxicity may occur - Monitor blood tests: WBC; serum levels; peak 1 hr after 1-hr inf 25-40 mg/L; trough before next dose 5-10 mg/L, especially in renal disease - Obtain C&S before product therapy; product may be given as soon as culture is performed - Assess auditory function during, after treatment; hearing loss, ringing, roaring in ears; product should be discontinued - Monitor B/P during administration; sudden drop may indicate red man syndrome - Assess for signs of infection - Red man syndrome: flushing of neck, face, upper body, arms, back; may lead to anaphylaxis, slow IV infusion to > 1 hr
Patient/family education - Teach patient aspects of product therapy: need to complete entire course of medication to ensure organism death (7-10 days); culture may be performed after completed course of medication - Advise patient to report sore throat, fever, fatigue; could indicate superinfection - Instruct patient that product must be taken in equal intervals around the clock to maintain blood levels
Evaluation
Positive therapeutic outcome: Absence of fever, sore throat; Negative culture after treatment
Reference
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