What are the contraindications to Vancomycin (vancomycin hydrochloride)?

From the Guidelines

Vancomycin is contraindicated in patients with a history of hypersensitivity to the medication, and its use should be cautiously considered in patients with renal dysfunction, hearing loss, or those receiving other nephrotoxic or ototoxic agents.

Contraindications and Precautions

• Hypersensitivity reactions: Vancomycin can cause anaphylaxis and other hypersensitivity reactions, and is therefore contraindicated in patients with a known history of hypersensitivity to the medication.
• Renal dysfunction: Vancomycin is primarily excreted through the kidneys, and its use should be cautiously considered in patients with renal dysfunction, as it may increase the risk of nephrotoxicity 1.
• Hearing loss: Vancomycin can cause ototoxicity, particularly when used in combination with other ototoxic agents, and its use should be cautiously considered in patients with pre-existing hearing loss.
• Nephrotoxicity: Vancomycin can increase the risk of nephrotoxicity when used in combination with other nephrotoxic agents, such as aminoglycosides 1.

Special Considerations

• Dosing: Vancomycin doses should be adjusted based on the patient's estimated creatinine clearance, and trough concentrations should be monitored in patients with serious infections, renal dysfunction, or fluctuating volumes of distribution 1.
• Combination therapy: The use of vancomycin in combination with other agents, such as rifampin or aminoglycosides, should be cautiously considered due to the increased risk of nephrotoxicity or ototoxicity 1.
• Alternative agents: In patients with renal insufficiency or at risk of nephrotoxicity, alternative agents such as linezolid may be preferred due to their lower risk of nephrotoxicity and easier dosing regimen 1.

From the FDA Drug Label

Vancomycin hydrochloride for injection is contraindicated in patients with known hypersensitivity to this antibiotic [ 2 ].

• The contraindication is based on the potential for an anaphylactoid reaction or other severe hypersensitivity response.
• There is no other contraindication mentioned in the provided drug labels [ 2 ] [ 2 ].
• It is essential to carefully review the patient's medical history before administering vancomycin to minimize the risk of an adverse reaction.

From the Research

Contraindications to Vancomycin

The following are contraindications to vancomycin:

• Hypersensitivity to vancomycin 3
• Patients with known history of vancomycin-induced nephrotoxicity or ototoxicity 4, 3, 5
• Patients with renal dysfunction, as vancomycin can exacerbate existing renal impairment 4, 6
• Patients with hepatic dysfunction, as vancomycin can cause elevated liver enzymes 4
• Patients with compromised bone marrow function, as vancomycin can cause neutropenia 5

Special Considerations

The following conditions require special consideration when using vancomycin:

• Patients with hypertension or diabetes, as they may be at increased risk of side effects 4
• Patients receiving vancomycin for prolonged periods, as they may be at increased risk of nephrotoxicity 5, 6
• Patients with elevated vancomycin minimum inhibitory concentrations (MICs), as they may be at increased risk of treatment failure 5, 6

Monitoring and Dosing

To minimize the risk of adverse effects, the following monitoring and dosing strategies are recommended:

• Therapeutic drug monitoring (TDM) to maintain trough concentrations within a target range 4, 6
• Area under the curve (AUC)-guided dosing strategies to reduce the risk of acute kidney injury (AKI) 7
• Dose adjustment in patients with renal dysfunction or other risk factors for nephrotoxicity 6