From the Guidelines
Vancomycin is a powerful glycopeptide antibiotic primarily used to treat serious infections caused by gram-positive bacteria, especially methicillin-resistant Staphylococcus aureus (MRSA). It works by inhibiting bacterial cell wall synthesis, preventing bacteria from forming proper cell walls and ultimately causing their death.
Key Points
- Vancomycin is typically administered intravenously in hospital settings, with standard adult dosing around 15-20 mg/kg every 8-12 hours, adjusted based on kidney function and drug level monitoring, as recommended by the Infectious Diseases Society of America 1.
- For certain infections like Clostridium difficile colitis, it can be given orally.
- Common side effects include infusion-related reactions ("red man syndrome"), kidney damage, and hearing loss.
- Due to concerns about antibiotic resistance, vancomycin is generally reserved for serious infections where other antibiotics would be ineffective.
- Blood level monitoring is essential during treatment to maintain therapeutic levels (typically 15-20 μg/mL for trough concentrations) while avoiding toxicity, with trough concentrations of 15–20 lg/mL recommended for serious infections 1.
- Vancomycin requires careful administration and monitoring by healthcare professionals due to its narrow therapeutic window.
Administration and Monitoring
- The dosage of vancomycin should not exceed 2 g per dose in patients with normal renal function, as stated in the clinical practice guidelines by the Infectious Diseases Society of America 1.
- The use of continuous vancomycin infusions has not been shown to be clearly advantageous compared with twice-daily dosing 1.
- Optimal dosing of vancomycin may not have been achieved in all patients, and prospective confirmation of these results is needed 1.
From the FDA Drug Label
Vancomycin is a tricyclic glycopeptide antibiotic derived from Amycolatopasis orientalis (formerly Nocardia orientalis)
- Vancomycin is a tricyclic glycopeptide antibiotic.
- It is derived from Amycolatopasis orientalis (formerly Nocardia orientalis) 2.
From the Research
Definition and Mechanism of Vancomycin
- Vancomycin is a tricyclic glycopeptide antibiotic produced by Streptococcus orientalis 3.
- It is used to fight severe infections caused by Gram-positive bacteria, especially methicillin-resistant Staphylococcus aureus (MRSA) and penicillin-resistant pneumococci 3, 4.
- Vancomycin works by altering cell wall structure and metabolism, making it effective against Gram-positive bacteria 4.
Clinical Indications and Usage
- Vancomycin is indicated for the treatment of patients allergic to penicillins and cephalosporins 3.
- It is used to treat various infections, including skin and soft tissue infections, hospital-acquired pneumonia, and bacteremia 5, 6.
- Vancomycin is often used as a drug of last resort, but its use is still common despite the emergence of resistant strains 4, 6.
Adverse Effects and Resistance
- The main adverse effects of vancomycin include hypotension, phlebitis, nephrotoxicity, ototoxicity, and hypersensitivity reactions 3.
- Vancomycin-resistant Staphylococcus aureus (VRSA) and vancomycin intermediate-resistant S. aureus (VISA) strains have been described, with resistance mechanisms involving alterations in cell wall structure and metabolism 4.
- The emergence of resistance highlights the need for optimized administration and monitoring of vancomycin treatment to ensure safe and effective use 3, 6.