Spectrum: Local Antimicrobial Stewardship, for Bakersfield Memorial Hospital

Vancomycin IV

C. diff Risk

None

Oral Bioavailability

NA

Approximate Cost

Spectrum Of Activity

General Spectrum of Activity

Spectrum Of Activity

General Spectrum of Activity

Antibiogram Data

Dosing

Renal

Adult

15 mg/kg IV every 8-12 hr depending on trough goal

Complicated infections in seriously ill patients
25-30 mg/kg IV loading dose rounded to nearest 250 mg (max of 2 gm per dose)

Recommend dose per Pharmacy

Pediatric

General Information

Acceptable Uses

Acceptable Uses

  • Treatment of infections by gram positive organisms in patients who have severe allergic reactions to beta-lactam antibiotics

  • Suspected or proven MRSA, coagulase-negative Staphylococci, Ampicillin-resistant Enterococcus, or ceftriaxone resistant S. pneumonia (CSF only) infections

Note: Empiric therapy should be discontinued within 72 hours if the below criteria are not met. Proven:

  • MRSA

  • Methicillin-resistant coagulase-negative staphylococci

  • Ampicillin-resistant enterococcus

  • Ceftriaxone-resistant S. pneumonia (CSF only)

  • Closdtridium difficile infection (oral therapy)

Unacceptable Uses

Unacceptable Uses

  • Treatment of a single-positive blood culture for coagulase-negative staphylococci

  • Continued empiric use for presumed infection with negative cultures

  • Prophylaxis for infection or colonization of indwelling intravascular or intracranial catheters

  • Routine surgical prophylaxis (exceptions listed in guideline section)

Common Usage

Common Usage

Suspected or proven MRSA, coagulase-negative Staphylococcal infections, Enterococcal infections.

Drug Monitoring

Drug Monitoring

Lab

  • Collect trough 30 min -1 hr before 4th dose

  • Target trough 10-15 mcg/mL for most serious infections, 15-20 mcg/mL for CNS infections, Pneumonia, osteomyelitis, and Endocarditis.

  • If trough low, increase dose (do not exceed 2g/dose) OR decrease dosing interval.

  • If trough >20, increase dosing interval or decrease dose

  • Baseline and at least weekly SCr (for dose and nephrotoxicity assessment)

Clinical

  • Hypersensitivity

  • Red man syndrome (slow down infusion)

  • Phlebitis

  • GI effects

Adverse Effects

Adverse Effects

  •  Nephrotoxicity

  •  Cytopenias

  •  Rash including Stevens-Johnson Syndrome

  •  Red man syndrome (histamine release: slow down infusion)

Major Interactions

Major Interactions

Aminoglycosides may potentiate nephrotoxicity

May enhance neuromuscular blockade of NM blocking agents

Careful with concomitant nephrotoxins

Additional Information

Additional Information

  • ID consult is strongly advised for proven MRSA infections and for all S. aureus bloodstream infections

  • Target levels vary based on site of infection. Consult Infectious Disease or Pharmacy for assistance

Pharmacology

Pharmacology

Antimicrobial class: Glycopeptide

Pregnancy category: C

Average serum half life: 8 hours

Biliary penetration: Moderate

CSF penetration: Moderate

Lung penetration: Therapeutic

Urine penetration: Therapeutic