From the Guidelines
Vancomycin is contraindicated in patients with a known hypersensitivity to the drug, as it can cause severe allergic reactions, including anaphylaxis. The use of vancomycin is also cautioned in patients with renal impairment, as it can exacerbate kidney damage 1. Additionally, vancomycin should be used with caution in patients with a history of vancomycin-induced nephrotoxicity or ototoxicity, as these conditions can worsen with repeated exposure to the drug.
- Renal impairment: Vancomycin doses should be adjusted according to the patient's estimated creatinine clearance, not to exceed 2 g per dose 1.
- Nephrotoxicity and ototoxicity: Patients with a history of vancomycin-induced nephrotoxicity or ototoxicity should be closely monitored, and alternative treatments should be considered if possible.
- Serious infections: For serious infections, such as bacteremia, infective endocarditis, osteomyelitis, meningitis, pneumonia, and severe skin and soft tissue infections (SSTI), vancomycin trough concentrations of 15–20 lg/mL are recommended 1.
- Monitoring: Trough vancomycin monitoring is recommended for serious infections and patients who are morbidly obese, have renal dysfunction, or have fluctuating volumes of distribution 1.
- Dosing: Vancomycin doses of 15–20 mg/kg/day every 8–12 h are recommended for adult patients, based on actual body weight and adjusted for the patient’s estimated creatinine clearance 1.
- Alternative treatments: In cases where vancomycin is contraindicated or not effective, alternative treatments such as linezolid, daptomycin, or other antibiotics may be considered 1.
From the FDA Drug Label
Contraindications for Vancomycin
There are no explicit contraindications mentioned in the provided drug label for Vancomycin hydrochloride [ 2 ]. However, the label does provide warnings and precautions for its use, including:
- Rapid infusion-related reactions, such as hypotension, shock, and cardiac arrest [ 2 ]
- Nephrotoxicity and acute kidney injury (AKI), especially in patients with underlying renal impairment [ 2 ]
- Ototoxicity, which may be transient or permanent [ 2 ]
- Severe dermatologic reactions, such as toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), and drug reaction with eosinophilia and systemic symptoms (DRESS) [ 2 ]
- Clostridium difficile associated diarrhea (CDAD) [ 2 ]
- Hemorrhagic occlusive retinal vasculitis (HORV), including permanent loss of vision, associated with intracameral or intravitreal administration [ 2 ]
Warnings and Precautions
The following warnings and precautions are noted:
- Vancomycin should be used with caution in patients with renal insufficiency [ 2 ]
- Dosage must be adjusted for patients with renal dysfunction [ 2 ]
- Vancomycin is not indicated for the prophylaxis of endophthalmitis [ 2 ]
From the Research
Contraindications for Vancomycin
The contraindications for Vancomycin are not explicitly stated in the provided studies. However, the studies do mention certain conditions and factors that may increase the risk of adverse effects or reduce the effectiveness of Vancomycin.
Adverse Effects and Precautions
- Hypersensitivity reactions, including anaphylaxis 3, 4
- Nephrotoxicity, especially with high doses or prolonged therapy 3, 4, 5, 6
- Ototoxicity 3, 5
- Red man syndrome 3, 4
- Neutropenia 3
- Chills and fever 3
- Interstitial nephritis 3
- Renal dysfunction, which may require dose adjustment 5
- Hepatic dysfunction, which may require monitoring of liver function tests 5
- Hypertension and diabetes, which may increase the risk of side effects 5
Special Considerations
- Vancomycin should be used with caution in patients with renal impairment, as it may accumulate to toxic levels 5, 6
- Patients with hepatic impairment should be monitored closely for signs of toxicity 5
- Vancomycin should not be used alone in enterococcal endocarditis, but rather in combination with an aminoglycoside 7
- Vancomycin may not be effective against certain strains of bacteria, such as vancomycin-resistant Enterococcus faecium 4