1. IV infusion by syringe pump over 60 minutes.    

1. 10 mg/kg per dose Q6 hours for 5 to 7 days. The injectable preparation may be given PO.

Indications

1. Suspected/proven infection with methicillin resistant staphylococci species (coagulase negative staphylococci, Staphylococcus aureus).
2. Treatment of colitis caused by Clostridia difficile (oral administration).

Contraindications and Precautions

1. Known hypersensitivity to vancomycin.
2. Use in treatment of minor infections.
3. Concurrent/sequential use of other ototoxic/nephrotoxic drugs.
4. Caution in preterm infants, especially extreme immaturity.
5. Caution in infants with renal impairment.

Clinical Pharmacology

Narrow spectrum bacteriocidal antibiotic which inhibits bacterial cell wall mucopeptide synthesis. Almost all pathogenic strains of coagulase negative staphylococci and staphylococci aureus, including those which are methicillin resistant, are susceptible to vancomycin.

Diffuses readily into pleural, pericardial, ascitic and synovial fluids, but not CSF. Moderate binding (55-60%) to human plasma protein. There is no apparent metabolism of the drug. Eliminated primarily by the kidney.

Possible Adverse Effects

1. Venous irritation, soft tissue injury at IV injection site.
2. Hypotension and/or hypersensitivity reactions (chills, fever, rash) with rapid intravenous injection.
3. Respiratory depression, apnoea secondary to neuromuscular blockade.
4. Gastrointestinal disturbances (nausea, vomiting, diarrhoea).
5. Neutropenia, thrombocytopenia.
6. Nephrotoxicity.
7. Ototoxicity.
8. Hypersensitivity reactions and/or anaphylaxis.

Special Considerations

1. Concomitant administration with anaesthetic agents has been associated with erythema, histamine-like flushing and anaphylaxis.
2. Adjust dose and/or dosing interval in infants with suspected or proven renal impairment, or reduced clearance of vancomycin due to extreme immaturity.
3. Obtain serum peak and trough level after 3rd dose. Repeat every 3 - 5 days. Desired peak level 2 hours after completion of drug infusion 20-35 mg/L. Trough level immediately prior to next dose should be 5-10 mg/L.
4. Obtain serum peak level and trough serum levels after the first dose in infants with suspected/proven renal impairment.
5. Vancomycin is never administered by intramuscular injection. May cause necrosis.