From the Guidelines
Vancomycin is contraindicated in patients with a known hypersensitivity or allergic reaction to vancomycin or any component of its formulation. When considering the use of vancomycin, it is essential to weigh the potential benefits against the risks, particularly in patients with certain underlying conditions. According to the provided evidence 1, vancomycin therapy is recommended only for patients unable to tolerate penicillin or ceftriaxone, highlighting the importance of careful patient selection. Some key considerations for vancomycin use include:
- Patients with renal impairment, as vancomycin is primarily eliminated by the kidneys and can accumulate to toxic levels without appropriate dose adjustment
- Patients with hearing impairment or previous ototoxicity, as vancomycin can cause or exacerbate hearing loss
- Pregnant women, as vancomycin is classified as pregnancy category C and should be used only if clearly needed
- Patients receiving other nephrotoxic or ototoxic medications, such as aminoglycosides, as concurrent use may increase the risk of adverse effects It is crucial to monitor patients closely and adjust vancomycin dosages accordingly to minimize the risk of adverse effects, as outlined in the guidelines 1. In particular, vancomycin dosages should be infused during the course of at least 1 hour to reduce the risk of histamine-release "red man" syndrome, and peak and trough serum concentrations should be monitored to ensure optimal therapy 1. Ultimately, the decision to use vancomycin should be made on a case-by-case basis, taking into account the individual patient's needs and potential risks.
From the FDA Drug Label
Vancomycin hydrochloride for injection is contraindicated in patients with known hypersensitivity to this antibiotic. The main contraindication to vancomycin is:
- Known hypersensitivity to this antibiotic 2
From the Research
Contraindications to Vancomycin
The following are some contraindications to vancomycin:
- Hypersensitivity reactions, including anaphylaxis and vancomycin-induced anaphylactic reaction 3
- Vancomycin-associated drug-induced hypersensitivity syndrome (DIHS), or drug reaction with eosinophilia and systemic symptoms (DRESS) 4
- Vancomycin infusion reaction, previously called "red man syndrome", which can cause symptoms such as flushing, pruritis, angioedema, bronchospasm, and hypotension 5, 6
- Nephrotoxicity and ototoxicity, as vancomycin can cause renal dysfunction and hearing loss 4, 3
- Severe cutaneous adverse reactions, including drug reaction eosinophilia and systemic symptoms syndrome 7
Special Considerations
Some patients may require special consideration when using vancomycin, including: