From the Guidelines
Vancomycin is contraindicated in patients with known hypersensitivity to the drug, and its use should be avoided or approached with caution in patients with renal impairment, hearing loss, or those receiving other nephrotoxic or ototoxic medications.
- The primary concern with Vancomycin use is its potential for nephrotoxicity, particularly in patients with pre-existing renal impairment or those receiving other nephrotoxic agents, such as aminoglycosides 1.
- Renal dysfunction is a significant predictor of Vancomycin failure, and dosing should be adjusted accordingly to avoid toxicity 1.
- Trough Vancomycin monitoring is recommended for serious infections and patients who are morbidly obese, have renal dysfunction, or have fluctuating volumes of distribution to minimize the risk of toxicity 1.
- Hypersensitivity reactions, including anaphylaxis, can occur with Vancomycin use, and patients with a known history of hypersensitivity should avoid the drug.
- Ototoxicity is another potential concern with Vancomycin use, particularly in patients with pre-existing hearing loss or those receiving other ototoxic medications 1.
- Vancomycin-induced neutropenia or leukopenia can also occur, and patients should be monitored for signs of hematologic abnormalities 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 following are contraindications for Vancomycin:
- Hypersensitivity to vancomycin 3, 4, 5
- Patients with known history of vancomycin-induced nephrotoxicity or ototoxicity 3, 4, 5
- Patients with renal dysfunction, as vancomycin can exacerbate existing kidney problems 3, 4, 6, 7
- Patients with hepatic dysfunction, as vancomycin can affect liver function 3, 5
- Patients with compromised renal function, as vancomycin can increase the risk of acute kidney injury (AKI) 6, 7
Special Considerations
- Vancomycin should be used with caution in patients with:
- Hypertension or diabetes, as these conditions may increase the risk of side effects 3
- Prolonged use of vancomycin, as this can increase the risk of nephrotoxicity and ototoxicity 4, 5, 6, 7
- Concomitant use of other nephrotoxic or ototoxic agents, as this can increase the risk of adverse effects 4, 5, 6, 7