From the Guidelines
Yes, IV vancomycin can be reconstituted for oral use in specific clinical situations, particularly for treating Clostridioides difficile infections, as noted in the guidelines for the treatment of CDI in Taiwan 1. To prepare it, reconstitute the IV vancomycin powder with sterile water to a concentration of 125-500 mg per dose, typically administered four times daily for 10-14 days. The reconstituted solution should be mixed in a flavored liquid like juice or given in gelatin capsules to mask the bitter taste. This approach is used because commercial oral vancomycin is expensive and sometimes unavailable. Oral vancomycin works differently than IV vancomycin - when taken orally, it remains in the gut and isn't significantly absorbed into the bloodstream, allowing it to directly target C. difficile in the intestines. Some key points to consider when using IV vancomycin orally include:
- The importance of medical supervision to ensure proper dosing and administration
- The need to refrigerate the reconstituted solution and use it within 14 days
- The potential for metronidazole-related neurotoxicity with prolonged or repeated use, as noted in the clinical practice guidelines for CDI 1
- The existence of other treatment options, such as fidaxomicin and fecal microbiota transplantation, which may be considered in certain clinical situations, as discussed in the guidelines for the treatment of CDI in adults and children 1. It is essential to follow the guidelines and recommendations from reputable sources, such as the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA), when treating CDI. In general, the treatment of CDI should be individualized based on the severity of the disease, the presence of risk factors for recurrence, and the patient's response to treatment. By considering these factors and following established guidelines, healthcare providers can optimize treatment outcomes and reduce the risk of complications and recurrence.
From the FDA Drug Label
Parenteral administration of vancomycin is not effective for the above infections; therefore, vancomycin hydrochloride capsules must be given orally for these infections. If parenteral vancomycin therapy is desired, use an intravenous preparation of vancomycin and consult the package insert accompanying that preparation.
The FDA drug label does not support reconstituting IV Vancomycin for oral use. Oral vancomycin is specifically designed for oral administration, and IV vancomycin is designed for intravenous use. The labels clearly state that parenteral administration of vancomycin is not effective for certain infections and that oral vancomycin must be given orally for those infections. Therefore, it is not recommended to reconstitute IV Vancomycin for oral use 2, 2, 2.
From the Research
Reconstituting IV Vancomycin for Oral Use
- There is no direct evidence in the provided studies to support the reconstitution of Intravenous (IV) Vancomycin for oral use.
- The studies primarily focus on the comparison of treatments for Clostridioides difficile infection (CDI), including vancomycin, fidaxomicin, and metronidazole, in various patient populations 3, 4, 5, 6, 7.
- Vancomycin is commonly administered orally for the treatment of CDI, but the provided studies do not address the reconstitution of IV Vancomycin for oral use.
- It is essential to note that IV Vancomycin is formulated for intravenous administration, and its use orally may not be recommended or supported by the available evidence.
- Without specific guidance from the studies or other reliable sources, it is not possible to provide a definitive answer to the question of reconstituting IV Vancomycin for oral use.