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 and increase the risk of nephrotoxicity 1. Additionally, vancomycin should be used with caution in patients with a history of vancomycin-induced ototoxicity, as it can cause permanent hearing loss.
- Hypersensitivity reactions: Vancomycin can cause severe allergic reactions, including anaphylaxis, and is contraindicated in patients with a known hypersensitivity to the drug.
- Renal impairment: Vancomycin can exacerbate kidney damage and increase the risk of nephrotoxicity, and its use should be cautious in patients with renal impairment.
- Ototoxicity: Vancomycin can cause permanent hearing loss, and its use should be cautious in patients with a history of vancomycin-induced ototoxicity.
- Red man syndrome: Vancomycin can cause red man syndrome, a condition characterized by flushing, rash, and hypotension, which can occur when the drug is administered too quickly.
It is essential to carefully consider the individual patient's risk-benefit profile before using vancomycin, especially in cases of life-threatening infections, such as methicillin-resistant Staphylococcus aureus (MRSA) sepsis 1. The decision to use vancomycin in a patient with a contraindication requires careful consideration of the potential benefits and risks, and alternative treatments should be considered when possible.
In terms of dosing, vancomycin doses of 15–20 mg/kg/day every 8–12 h are recommended for adult patients, with adjustments made for the patient's estimated creatinine clearance 1. Trough vancomycin monitoring is recommended for serious infections and patients who are morbidly obese, have renal dysfunction, or have fluctuating volumes of distribution 1.
Overall, while vancomycin can be an effective treatment for certain infections, its use requires careful consideration of the potential risks and benefits, and alternative treatments should be considered when possible.
From the FDA Drug Label
Contraindications for Vancomycin
| Contraindication | Description | Reference |
|---|---|---|
| Hypersensitivity | Known hypersensitivity to vancomycin hydrochloride for injection | [@8403695c-3614-490b-9797-6c5ebcdeef9b-3@] |
Warnings and Precautions
- Infusion Reactions: Rapid bolus administration may be associated with exaggerated hypotension, including shock and rarely cardiac arrest [@8403695c-3614-490b-9797-6c5ebcdeef9b-1@]
- Nephrotoxicity: Systemic vancomycin exposure may result in acute kidney injury (AKI) [@8403695c-3614-490b-9797-6c5ebcdeef9b-1@]
- Ototoxicity: Ototoxicity has occurred in patients receiving vancomycin hydrochloride for injection [@8403695c-3614-490b-9797-6c5ebcdeef9b-1@]
- Severe Dermatologic Reactions: Severe dermatologic reactions such as toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), drug reaction with eosinophilia and systemic symptoms (DRESS), acute generalized exanthematous pustulosis (AGEP), and linear IgA bullous dermatosis (LABD) have been reported [@8403695c-3614-490b-9797-6c5ebcdeef9b-1@]
- Clostridium Difficile Associated Diarrhea (CDAD): CDAD has been reported with use of nearly all antibacterial agents, including vancomycin hydrochloride for injection [@8403695c-3614-490b-9797-6c5ebcdeef9b-1@]
- Hemorrhagic Occlusive Retinal Vasculitis (HORV): Hemorrhagic occlusive retinal vasculitis, including permanent loss of vision, occurred in patients receiving intracameral or intravitreal administration of vancomycin during or after cataract surgery [@8403695c-3614-490b-9797-6c5ebcdeef9b-1@]
From the Research
Contraindications for Vancomycin
The contraindications for Vancomycin are not explicitly stated in the provided studies. However, the studies do mention several adverse effects and potential risks associated with Vancomycin use, including:
- Hypersensitivity reactions 2, 3
- Nephrotoxicity 2, 4, 5, 3, 6
- Ototoxicity 2, 4, 3
- Phlebitis 2, 3
- Red man syndrome 2, 4
- Neutropenia 2
- Chills 2
- Fever 2
- Interstitial nephritis 2
- Agranulocytosis 3
Special Considerations
Certain patient populations may be at higher risk for adverse effects, including:
- Patients with renal dysfunction 4, 6
- Patients with hepatic dysfunction 4
- Patients with hypertension or diabetes 4
- Patients receiving prolonged therapy or high doses of Vancomycin 2, 4, 5
Monitoring and Precautions
To minimize the risk of adverse effects, careful monitoring and precautions are recommended, including: