Vancomycin

Vancomycin

Table of Contents

  1. What is Vancomycin?
  2. Constituents
  3. Indications
  4. How does Vancomycin work?
  5. How to Take Vancomycin?
  6. Common dosage for Vancomycin
  7. When to Avoid Vancomycin?
  8. Side-effects of Vancomycin
  9. Effects on organs
  10. Reported Allergic Reactions
  11. Effect of the medicine on the menstrual cycle
  12. Drug Interactions to Be Careful About
  13. Food interactions
  14. Interactions with laboratory procedures
  15. Shows Effects / Results in (how long does the effect stay?)
  16. Is Vancomycin Addictive?
  17. Can I have Vancomycin with alcohol?
  18. Can I have Vancomycin When Pregnant?
  19. Can I have Vancomycin when feeding a baby?
  20. Can I drive after taking Vancomycin?
  21. Effect of an overdose of Vancomycin
  22. Effect of using expired Vancomycin
  23. Effect of missing a dose
  24. Storage requirements
  25. Substitutes for Vancomycin

What is Vancomycin?

Vancomycin is an antibiotic that is used to treat bacterial infections. Vancomycin is mainly prescribed in the form of injections intravenously. It is also available as capsules and oral liquid for oral intake but the absorption through this form is very poor. Oral vancomycin works only in intestines. Hence, it is used to treat an intestinal infection like Clostridium difficile which causes severe diarrhea. Vancomycin Injection, USP is used for treating a wide range of Gram-positive bacterial infections.

Classification of the drug: Vancomycin is a Glycopeptide antibiotic.

What does USP mean?

USP in the Vancomycin injection label means the Unites States Pharmacopeia. This label ensures the quality, identity, potency, and purity.

Manufacturers:

  • It is manufactured by Bioniche Pharma, Baxter Healthcare, Sandoz, Akorne-Strides, Hospira in the USA.
  • Oral Vancomycin which is manufactured by CutisPharma’s Firvanq is FDA approved.

List of bacterial infections which can be treated by Vancomycin Injection:

  • Diphtheroids
  • Enterococci
  • Staphylococci- aureus and epidermidis.
  • Streptococcus Bovis
  • Streptococcus Viridians

Infections which can be treated by Oral Vancomycin:

  • Clostridium Difficile
  • Staphylococcal Enterocolitis

Brands names available in the USA:

  • Vancocin
  • Firvanq
  • Vancocin HCL
  • Lyphocin

Constituents

Vancomycin injection contains Vancomycin Hydrochloride in dextrose hydrous or sodium chloride USP. Sodium hydroxide or HCL is added to adjust the pH of the solution.

Indications

  • Severe infections caused by staphylococcus.
  • Infections caused by methicillin-resistant strains.
  • Patients allergic to penicillins and infections not responding to penicillins or cephalosporins.
  • Indicated as initial therapy when the methicillin-resistant strains are suspected but later dosage can be adjusted or changed to other antibiotics.
  • Indicated to treat Staphylococcal Endocarditis.
  • Infections like septicemia, bone infections, lower respiratory tract infections, and skin infections.
  • As an adjuvant therapy along with surgery in treating pus discharge in case of localized infection caused by Staphylococcal strains.
  • In the case of endocarditis caused by S.viridans.
  • Used in combination with aminoglycosides to treat endocarditis caused by Enterococci.
  • Endocarditis caused by Diphtheroids.
  • The oral form is indicated only for C.difficile diarrhea and enterocolitis caused by staphylococci.

How does Vancomycin work?

Vancomycin interacts with the bacterial cell wall formation of gram-positive bacteria. In gram-negative bacteria, the cell wall formation mechanism is different from that of gram-positive bacteria. Hence it is not effective in treating gram-negative bacterial infections.

How to Take Vancomycin?

Vancomycin injection is available as 100ml, 150ml, 200ml solutions containing 500mg, 750mg, 1gm Vancomycin in the form of Vancomycin Hydrochloride. It is given by a nurse or doctor in a hospital intravenously.

It is usually prescribed as 2g divided into 4 doses of 500mg each for every 6hours or 1g for every 12 hours.

Common dosage for Vancomycin

Tablet form: It is available as 125mg, 250mg capsules. It can be taken with or without food.

Adults:

  • Clostridium Difficile Diarrhoea: – 125mg, 4 times daily for 10 days.
  • Enterocolitis: – 500mg to 2g, 3 or 4 times daily for 10 days.

Children:

  • 40 mg/kg in 3 to 4 doses for 10days. The total dose should not exceed 2g per day.

For patients with renal impairment, the dosage will be adjusted by your doctor accordingly.

Please note: Details mentioned here are for informational purposes only and shall not be considered as medical advice.

When to Avoid Vancomycin?

  • Vancomycin is contraindicated in patients with known allergies to this antibiotic.
  • Injection form should be avoided in people who are allergic to corn or corn products as it contains dextrose in the solution.
  • In older patients of age> 65 years having liver diseases, it is not recommended. However, your doctor may adjust the dosage or prescribe a combination therapy.

Side-effects of Vancomycin

  • Hypersensitivity reactions
  • Infusion reactions like- erythema, flushing, hypotension, urticaria, pruritis, and red neck.

Red man syndrome: The rash which appears on the face, neck and upper half of the body due to mast cell stimulation in response to Vancomycin is red man syndrome. It is seen often in younger patients and children. This is also called as Mississippi Mud.

  • Ototoxicity: Hearing impairment, vertigo, tinnitus, dizziness
  • Pseudomembranous colitis
  • Diarrhea, hypotension, chills, fever, headache, shortness of breath.
  • Super infections
  • Reversible neutropenia
  • Tenderness and discomfort at the injection site.
  • Thrombophlebitis
  • Reduced potassium levels.

Effects on organs

  • Infusion-related reactions
  • Acute kidney injury
  • Gastrointestinal- Nausea, pain in the abdomen, vomiting, diarrhea, flatulence.
  • Ears: Patients with hearing problems have shown hearing loss.
  • Blood: Reversible neutropenia, phlebitis

It is good to share the previous history of health conditions such as inflammatory bowel disease, Ulcerative Colitis, Kidney problems, Hearing difficulties with your doctor.

Reported Allergic Reactions

Red man Syndrome is the most common allergic reaction reported with the usage of Vancomycin. Rapid infusion of this drug intravenously has shown urticaria, dyspnea, pruritis, and muscle spasm. Phlebitis at the injection site is also reported in some cases.

Effect on the menstrual cycle

It does not show any effects on menstrual cycles. Please consult your gynecologist if you observe any changes in your menstrual cycle after using this medication.

Drug Interactions to Be Careful About

Vancomycin may interfere with

  • Antibiotics like Amikacin, Amphotericin, Colistin, Gentamicin, Piperacillin, Neomycin and Tobramycin                                                                               
  • Cisplatin
  • Diuretics like Ethacrynic acid and Frusemide
  • Anaesthetic agents
  • Cholestyramine
  • Muscle relaxants like Suxamethonium or Vecuronium
  • Warfarin

Food interactions

There are no pieces of evidence showing Vancomycin being affected by the intake of specific foods. Please let your doctor know if you are taking any drugs, alcohol and over the counter vitamins.

Interactions with laboratory procedures

No consistent interactions with any specific laboratory procedures.

Shows Effects / Results in (how long does the effect stay?)

The effect of each dose of 500mg in adults stays for about 6hours. In 24hours, 75 to 80% of the drug is eliminated from the body.

 Is Vancomycin Addictive?

Both forms of Vancomycin are not addictive. However, injection is administered by trained professionals and addiction is not possible.

Can I have Vancomycin with alcohol?

Though it does not cause any serious interactions with alcohol, it is not advised to take alcohol while under this medication as this causes dizziness.

Can I have Vancomycin When Pregnant?

US FDA Pregnancy Category C: The effects of Vancomycin on the fetus are unknown and hence it is suggested to take Vancomycin if the potential benefits outweigh the risks. Let your doctor know if you are pregnant or taking any treatment to get pregnant.

Can I have Vancomycin when feeding a baby?

It is excreted into human breast milk. Therefore it is not safe to take Vancomycin during breast-feeding. Discuss with your doctor and pediatrician before taking this injection.

Can I drive after taking Vancomycin?

It is safe to drive after taking Vancomycin. Sometimes it may cause dizziness. It is advisable to be careful while driving or operating heavy machinery.

Effect of an overdose of Vancomycin

Overdosage is not possible as it is administered by a trained professional under a doctor’s supervision. In the case of oral forms, please contact your doctor if you have taken an excess dose.

Effect of using expired Vancomycin

The expired drug may not show the intended benefits. It may show adverse reactions instead. Properly dispose of the expired drug according to the instructions given on the label. The oral liquid should not be stored for more than 2 weeks.

Effect of missing a dose

Take the missed dose if it is not close to the next dose. If it is close to the next dose, skip the missed dose and take a regular dose. Set a reminder to avoid missing the dose.

Storage requirements

  • Keep the injection or oral forms of the drug in a safe and cool place of temperature less than 25°C.
  • Keep it away from children
  • Keep it away from pets.
  • The oral liquid should be stored in a refrigerator not more than 2 weeks. Later dispose of it.
  • Injections are stored in the hospitals or pharmacies following proper guidelines. If you are taking injections at home, please read the storage and thawing instructions properly.

Substitutes for Vancomycin

  • Glycopeptides like Dalbavancin
  • Daptomycin
  • Tigecycline
  • Linezolid
  • Ceftobiprole and Ceftaroline
  • Iclaprim

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