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DOSAGE
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Adults (Normal Renal Function): The usual daily intravenous dose is 2 g divided either as 500 mg every 6 hours or 1 g every 12 hours. Each dose should be administered at no more than 10 mg/min or over a period of at least 60 minutes, whichever is longer. Other patient factors, such as age or obesity, may call for modification of the usual intravenous daily dose.
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Pediatric patients (Normal Renal Function): The usual intravenous dosage of vancomycin is 10 mg/kg per dose given every 6 hours. Each dose should be administered over a period of at least 60 minutes. Close monitoring of serum concentrations of vancomycin may be warranted in these patients.
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Neonates(Normal Renal Function): In pediatric patients up to the age of 1 month, the total daily intravenous dosage may be lower. In neonates, an initial dose of 15 mg/kg is suggested, followed by 10 mg/kg every 12 hours for neonates in the 1st week of life and every 8 hours thereafter up to the age of 1 month. Each dose should be administered over 60 minutes. In premature infants, vancomycin clearance decreases as postconceptional age decreases. Therefore, longer dosing intervals may be necessary in premature infants. Close monitoring of serum concentrations of vancomycin is recommended in these patients.
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Patients with Impaired Renal Function and Elderly Patients: See DOSAGE TABLE FOR VANCOMYCIN IN PATIENTS WITH IMPAIRED RENAL FUNCTION
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GENERIC
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vancomycin 5%
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SIZE
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500mg/10mL Vial
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INDICATIONS
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Vancomycin Hydrochloride for Injection, USP is indicated for the treatment of serious or severe infections caused by susceptible strains of methicillin-resistant (β-lactam-resistant) staphylococci. It is indicated for penicillin-allergic patients, for patients who cannot receive or who have failed to respond to other drugs, including the penicillins or cephalosporins, and for infections caused by vancomycin-susceptible organisms that are resistant to other antimicrobial drugs. Vancomycin Hydrochloride for Injection, USP is indicated for initial therapy when methicillin-resistant staphylococci are suspected, but after susceptibility data are available, therapy should be adjusted accordingly.
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MECHANISM OF ACTION
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Glycopeptide: Binds to amino acids necessary for bacterial cell wall synthesis and alters bacterial cell membrane permeability.
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MICROBIOLOGY
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Narrow spectrum antibiotic. Bactericidal against certain gram-positive organisms. Not active against gram-negative bacilli, mycobacteria, or fungi. Vancomycin has been shown to be active against most strains of the following microorganisms, both in vitro and in clinical infections Aerobic gram-positive microorganisms Diphtheroids Enterococci (e.g., Enterococcus faecalis) Staphylococci, including Staphylococcus aureus and Staphylococcus epidermidis (including heterogeneous methicillin-resistant strains) Streptococcus bovis Viridans group streptococci. Vancomycin exhibits in vitro MIC's of 1 mcg/mL or less against most (≥90%) strains of streptococci listed below and MIC's of 4 mcg/mL or less against most (≥90%) strains of other listed microorganism Aerobic gram-positive microorganisms: Listeria monocytogenes Streptococcus pyogenes Streptococcus pneumoniae (including penicillin-resistant strains), Streptococcus agalactiae Anaerobic gram-positive microorganisms: Actinomyces species Lactobacillus species
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CONTRAINDICATIONS & WARNINGS
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Vancomycin hydrochloride for injection is contraindicated in patients with known hypersensitivity to this antibiotic.
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PEDIATRIC USE
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In pediatric patients, it may be appropriate to confirm desired vancomycin serum concentrations. Concomitant administration of vancomycin and anesthetic agents has been associated with erythema and histamine-like flushing in pediatric patients Systemically used in infants > 7 days.
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PREGNANCY
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Oral vancomycin is category B
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Injectable vancomycin is category C
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Teratogenic Effects Animal reproduction studies have not been conducted with vancomycin. It is not known whether vancomycin can affect reproduction capacity. In a controlled clinical study, the potential ototoxic and nephrotoxic effects of vancomycin on infants were evaluated when the drug was administered to pregnant women for serious staphylococcal infections complicating intravenous drug abuse. Vancomycin was found in cord blood. No sensorineural hearing loss or nephrotoxicity attributable to vancomycin was noted. One infant whose mother received vancomycin in the third trimester experienced conductive hearing loss that was not attributed to the administration of vancomycin. Because the number of patients treated in this study was limited and vancomycin was administered only in the second and third trimesters, it is not known whether vancomycin causes fetal harm. Vancomycin should be given to a pregnant woman only if clearly needed.
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NOTE
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The aqueous solution is unstable but may be kept refrigerated for 4 days (96hr).
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