VANCOMYCIN HYDROCHLORIDE

(van-koe-mye’sin)

Vancocin

Classifications: ANTIBIOTIC; GLYCOPEPTIDE

Therapeutic: ANTIBIOTIC

Pregnancy Category: B

Availability: 125 mg, 250 mg capsules; 500 mg, 1 g, 5 g, 10 g

injection

Action & Therapeutic Effect: Bactericidal action is due to inhibition

of cell-wall biosynthesis and alteration of bacterial cell-membrane
permeability and ribonucleic acid (RNA) synthesis. Active against many
gram-positive organisms.

Uses: Parenterally for potentially life-threatening infections in patients

allergic, nonsensitive, or resistant to other less toxic antimicrobial drugs.
Used orally only in Clostridium difficile colitis and staphylococcal
enterocolitis (not effective by oral route for treatment of systemic
infections).

Contraindications: Hypersensitivity to vancomycin, allergy to corn or

corn products, previous hearing loss.

Cautious Use: Impaired kidney function, renal failure, renal impairment,

hearing impairment; colitis, inflammatory disorders of the intestine; older
adults; pregnancy (category B), children, neonates.

Route & Dosage

Systemic Infections

Adult/Adolescent: IV 500 mg q6h or 1 g q12h or 15 mg/kg q12h

Common adverse effects in italic, life-threatening effects underlined; generic names

in bold; classifications in SMALL CAPS; Canadian drug name; Pr Prototype drug

Wilson, B., Shannon, M. T., & Shields, K. M. (2012). Vancomycin Hydrochloride. In Pearson Nurse's
Drug Guide 2012 (pp. 1566–1568). Upper Saddle River, NJ: Prentice Hall. 1
Child/Infant (older than 1 mo): IV 30–40 mg/kg/day divided q6–8h

Neonate: IV 10–15 mg/kg q8–24h

Clostridium difficile Colitis

Adult: PO 125–500 mg q6h

Child: PO 40 mg/kg/day divided q6h (max: 2 g/day)

Neonate: PO 10 mg/kg/day in divided doses

Surgical Prophylaxis (in Patients Allergic to Beta-Lactams)

Adult/Adolescent/Child (weight at least 27 kg): IV 10–15 mg/kg

starting 1 h before surgery

Child (weight less than 27 kg): IV 20 mg/kg starting 1 h before surgery

Staphylococcal Enterocolitis

Adult: PO 500 mg-2g in 3-4 divided doses x 7-10 days

Renal Impairment Dosage Adjustment

CrCl 40–60 mL/min: Dose q24h; less than 40 mL/min: Extend interval
based on monitoring levels

Hemodialysis Dosage Adjustment

Not dialyzed

Administration

Oral
• May be given with or without food.
• Note: Some parenteral products may be administered orally;
check manufacturer’s package insert.

Wilson, B., Shannon, M. T., & Shields, K. M. (2012). Vancomycin Hydrochloride. In Pearson Nurse's
2 Drug Guide 2012 (pp. 1566–1568). Upper Saddle River, NJ: Prentice Hall.
Intravenous

Prepare: Intermittent: Reconstitute 500 mg vial or 1 g vial with

10 mL or 20 mL, respectively, of sterile water for injection to yield
50 mg/mL. Further dilute each 500 mg with at least 100 mL and
each 1 g with at least 200 mL of D5W, NS, or LR.

Administer: Intermittent: Give a single dose at a rate of 10 mg/min

or over NOT LESS than 60 min (whichever is longer). Avoid rapid
infusion, which may cause sudden hypotension. Monitor IV site
closely; necrosis and tissue sloughing will result from extravasation.

Incompatibilities: Solution/additive: Aminophylline, BARBITURATES,

aztreonam (high concentration), calcium chloride, chloramphenicol,
chlorothiazide, dexamethasone, erythromycin, heparin,
methicillin, sodium bicarbonate, warfarin. Y-site: Albumin,
amphotericin B cholesteryl, aztreonam, bivalirudin, cefazolin,
cefepime, cefotaxime, cefotetan, cefoxitin, ceftazidime,
ceftriaxone, cefuroxime, drotrecogin, foscarnet, heparin,
idarubicin, lansoprazole, nafcillin, omeprazole, piperacillin/
tazobactam, sargramostim, ticarcillin, ticarcillin/clavulanate,
warfarin.    Store oral and parenteral solutions in refrigerator for up to
14 days; after further dilution, parenteral solution is stable 24 h at room
temperature.

Adverse Effects (≥1%): Special Senses: Ototoxicity (auditory

portion of eighth cranial nerve). Urogenital: Nephrotoxicity leading to
uremia. Body as a Whole: Hypersensitivity reactions (chills, fever,
skin rash, urticaria, shock-like state), anaphylactoid reaction with
vascular collapse, superinfections, severe pain, thrombophlebitis at
injection site, generalized tingling following rapid IV infusion.
Hematologic: Transient leukopenia, eosinophilia. GI: Nausea,
warmth. Other: Injection reaction that includes hypotension
accompanied by flushing and erythematous rash on face and upper
body (“red-neck syndrome”) following rapid IV infusion.

Interactions: Drug: Adds to toxicity of ototoxic and nephrotoxic drugs

(AMINOGLYCOSIDES, amphotericin B, colistin, capreomycin; cidofovir;
cisplatin; cyclosporine; foscarnet; ganciclovir; IV pentamidine;
polymyxin B; streptozocin; tacrolimus). Cholestyramine,
colestipol can decrease absorption of oral vancomycin; may increase
risk of lactic acidosis with metformin.

Wilson, B., Shannon, M. T., & Shields, K. M. (2012). Vancomycin Hydrochloride. In Pearson Nurse's
Drug Guide 2012 (pp. 1566–1568). Upper Saddle River, NJ: Prentice Hall. 3
Pharmacokinetics: Absorption: Not absorbed. Peak: 30 min after
end of infusion. Distribution: Diffuses into pleural, ascitic, pericardial,
and synovial fluids; small amount penetrates CSF if meninges are
inflamed; crosses placenta. Elimination: 80–90% of IV dose in urine
within 24 h; PO dose excreted in feces. Half-Life: 4–8 h.

Nursing Implications

Assessment & Drug Effects

• Monitor BP and heart rate continuously through period of drug
administration.
• Lab tests: Periodic urinalysis, LFTs, kidney functions, and
hematologic studies. Monitor serial tests of vancomycin blood
levels (peak and trough) in patients with borderline kidney
function, in infants and neonates, and in patients older than
60 y.
• Assess hearing. Drug may cause damage to auditory branch
(not vestibular branch) of eighth cranial nerve, with
consequent deafness, which may be permanent.
• Be aware that serum levels of 60–80 mcg/mL are associated
with ototoxicity. Tinnitus and high-tone hearing loss may
precede deafness, which may progress even after drug is
withdrawn. Older adults and those on high doses are especially
susceptible.
• Monitor I&O: Report changes in I&O ratio and pattern. Oliguria
or cloudy or pink urine may be a sign of nephrotoxicity (also
manifested by transient elevations in BUN, albumin, and hyaline
and granular casts in urine).

Patient & Family Education

• Notify prescriber promptly of ringing in ears.
• Adhere to drug regimen (i.e., do not increase, decrease, or
interrupt dosage. The full course of prescribed drug therapy
must be completed).

Wilson, B., Shannon, M. T., & Shields, K. M. (2012). Vancomycin Hydrochloride. In Pearson Nurse's
4 Drug Guide 2012 (pp. 1566–1568). Upper Saddle River, NJ: Prentice Hall.