From the Guidelines
Vancomycin is contraindicated in patients with a known hypersensitivity to the drug, as well as those with a history of vancomycin-induced nephrotoxicity or ototoxicity.
Contraindications and Precautions
- Hypersensitivity reactions: Vancomycin can cause severe allergic reactions, including anaphylaxis, in patients with a known hypersensitivity to the drug 1.
- Nephrotoxicity and ototoxicity: Vancomycin is contraindicated in patients with a history of vancomycin-induced nephrotoxicity or ototoxicity, as these conditions can worsen with repeated exposure to the drug 1.
- Renal impairment: Vancomycin should be used with caution in patients with renal impairment, as it can exacerbate kidney damage 1.
- Dosing considerations: Vancomycin doses should be adjusted according to the patient's estimated creatinine clearance, and trough concentrations should be monitored in patients with serious infections, morbid obesity, renal dysfunction, or fluctuating volumes of distribution 1.
Special Considerations
- Meningitis: Vancomycin is not recommended for use in patients with meningitis, as it has poor penetration into the cerebrospinal fluid 1.
- Vancomycin-resistant strains: Vancomycin is not effective against vancomycin-resistant strains of bacteria, and alternative treatments should be used in these cases 1.
From the FDA Drug Label
Contraindications for Vancomycin
| Contraindication | Description | Reference |
|---|---|---|
| Hypersensitivity | Known hypersensitivity to vancomycin hydrochloride for injection | [2] |
- Other warnings and precautions that may not be strictly contraindications but are important to consider when prescribing vancomycin include:
- Infusion reactions, including hypotension, shock, and cardiac arrest 2
- Nephrotoxicity, including acute kidney injury (AKI) 2
- Ototoxicity, including transient or permanent hearing loss 2
- Severe dermatologic reactions, including 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) 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 toxicity associated with Vancomycin use.
Adverse Effects and Toxicity
- Hypotension 3, 4
- Phlebitis 3
- Nephrotoxicity 3, 4, 5, 6, 7
- Ototoxicity 3, 4, 5
- Hypersensitivity reactions 3, 4
- Red man syndrome 3, 4, 5
- Neutropenia 3
- Chills 3
- Fever 3
- Interstitial nephritis 3
Special Considerations
- Patients with renal dysfunction may be at increased risk of nephrotoxicity 5, 7
- Patients with hepatic dysfunction may be at increased risk of adverse effects 5
- Patients with hypertension or diabetes may be at increased risk of side effects 5
- Prolonged therapy or high doses may increase the risk of toxicity and treatment failures 3, 4, 6