Description and indication for use
Vancomycin is a glycopeptide antibiotic
derived from Amycolatopsis orientalis
(formerly Nocardia orientalis).
Vancomycin is bactericidal against many Gram -ve bacteria. It is used for
suspected or proven MRSA infections or an infection caused by other organisms
when sensitivity tests indicate no other antibiotic is available.
Dose
IV:
Severe infection
15 mg/kg/dose
Preterm
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CA < 28 weeks
CA 28 to 32 weeks
CA > 32 to 36 weeks
CA ≥ 37 weeks
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24 hourly
18 hourly
12 hourly
8 hourly
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Term
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Week 1
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12 hourly
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Week 2 to 4
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8 hourly
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Reconstitution/Dilution
Vial = 500 mg.
IV:
To reconstitute add 10 mL
of water for injection to 500 mg vial
= 50 mg/mL solution.
Withdraw exact dose required and add
further dilute with sodium chloride 0.9% or glucose 5% to 5 mg/mL. DO NOT USE glucose
10% for dilution.
Alternatively: Withdraw 1 mL of 50 mg/mL
solution from the vial and add to 9 mL of Sodium Chloride 0.9% or Glucose 5% in
a 10 mL syringe = 5 mg/mL. Withdraw
required dose – no further dilution necessary.
* If fluid restricted can be diluted to 10 mg/mL and administered via
central line only.
Reconstituted vial (50 mg/mL solution) is
stable for 24 hours under refrigeration.
Route and method of administration
Not to be given by IM or SC injection.
IV:
Using Minimum Volume Extension tubing and
syringe pump, prime line with syringe containing exact dose of vancomycin.
Infuse over 2 hours (120 minutes).
Draw up 3 mL of Sodium Chloride 0.9% in a
10 mL syringe. Following completion of
the infusion, infuse 2 mLs of the Sodium Chloride 0.9% at the same infusion
rate as Vancomycin to flush the line (set volume limit for 2 mLs). Following
completion of infusion and flush, disconnect and discard line.
Side effects
Infusion related events - rapid bolus
administration may cause:
Hypotension, tachycardia, cardiac arrest
(rare), skin flushing, itch, thrombophlebitis (at injection site), “Red Man”
Syndrome – flushing or rash on the upper body and neck, muscle spasm of the
chest and back.
“Red Man” syndrome appears rapidly and
resolves within minutes to hours of ceasing infusion. If this occurs: cease infusion, re-check
dosage and infusion rate. Wait for
symptoms to resolve. Resume infusion at
a slower rate. Give all subsequent doses
at the slower infusion rate. Report and
document the adverse reaction.
Transient neutropenia, thrombocytopenia
(rare), ototoxicity, nephrotoxicity (rare – most reports occur in patients with
pre-existing hearing loss or renal impairment and when used in conjunction with
other nephrotoxic or ototoxic agents), hypersensitivity reactions (chills,
fever, rash).
Contraindications
Known hypersensitivity to Vancomycin.
Caution in patients allergic to Teicoplanin as allergic cross reactions
have been reported.
Vancomycin is not indicated for the
treatment of minor infections and infections for which other antibiotics are
available.
Concurrent use of other ototoxic/nephrotoxic
drugs, unless clearly indicated and closely monitored.
Special precautions
Renal impairment – careful monitoring of blood levels is recommended to
guide adjustments of dose/dosage interval.
Compatible Solutions
Glucose 5% and 10%.
Sodium Chloride 0.9%.
Compatible with TPN (nutrient and
intralipid solutions).
Compatible Drugs
Amikacin, Calcium Gluconate, Insulin, Midazolam,
Morphine, Pancuronium Bromide, Pantoprazole, Potassium Chloride (20 mmol/L), Ranitidine.
Incompatibilities
Vancomycin must not be mixed together with
the following drugs:
Adrenaline, Aminophylline,
Cefotaxime, Dexamethasone, Heparin Sodium (at higher concentrations > 1 unit/mL),
Phenobarbitone Sodium, Phenytoin Sodium, Sodium Bicarbonate.
Vancomycin is physically incompatible with beta-lactam antibiotics (eg: Benzylpenicillin, Ceftazidime, Ceftriaxone)
– ensure IV lines are adequately flushed with Sodium Chloride 0.9% between
administration of these antibiotics.
Drug interactions
Concomitant use with other nephrotoxic agents eg: Aminoglycoside Antibiotics, Amphotericin,
Indomethacin.
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Monitor renal function closely.
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Indomethacin
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Reduces the renal clearance of Vancomycin. A reduction in dose of Vancomycin may be
necessary.
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Frusemide
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Increases the risk of ototoxicity when used in
combination with Vancomycin.
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Neuromuscular
blockaders eg: Pancuronium, Suxamethonium, Vecuronium.
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Neuromuscular blockade may be enhanced.
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Nursing responsibilities
Therapeutic Drug Monitoring:
Ensure serum trough (pre) levels are routinely monitored on commencement of
treatment and after dosage changes, as outlined below:
When to monitor:
Neonates (normal renal function): sample immediately prior to 2nd dose.
Neonates (renal dysfunction): take spot
levels and repeat dose only when level is between 5 – 10 mg/L.
Therapeutic range: 10 – 15 mg/L.
Do not inject IM as it is very irritating
to tissue, and can cause necrosis.
Infuse slowly to avoid reactions associated
with rapid infusion and thrombophlebitis.
If extravasation occurs, check with medical
staff regarding possibility of using hyaluronidase around the periphery of the
affected area.
Visually inspect IV tubing for particulate
matter/discoloration.
Observe urinary output.