Vancomycin
VANCOCIN
Pronunciation: van-koe-MYE-sin
“Van Co. mice in”
purple stain → vancomycin is used to treat Gram-positive bacterial infections
What it isGlycopeptide inhibiting cell wall synthesis; MRSA and, orally, C. difficile.
Why this oneThe IV drug does not treat colitis and the oral drug does not treat bacteremia — the route defines the indication entirely.
What limits itNephrotoxicity at high troughs, so AUC-guided dosing is now preferred. Infusion reaction if given too fast.
Pearls
- Ototoxicity with high doses, long courses, renal impairment, elderly.
- Alternative for severe beta-lactam allergy.
FDA-approved for
- gram-positive infections (~1958)
Principal riskNephrotoxicity at elevated troughs; infusion reaction
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityAllergy, gastrointestinal effects and agent-specific renal, hepatic, hematologic or interaction risks.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| C. difficile-associated diarrhea | Adults ≥18 y | 125 mg QID ×10 days | 125 mg QID | |
| C. difficile-associated diarrhea | Peds <18 y | 40 mg/kg/day in 3–4 divided doses ×7–10 days | 40 mg/kg/day divided | 2 g/day |
| Staphylococcal enterocolitis | Adults ≥18 y | 500 mg–2 g/day in 3–4 divided doses ×7–10 days | 500 mg–2 g/day divided | 2 g/day |
| Staphylococcal enterocolitis | Peds <18 y | 40 mg/kg/day in 3–4 divided doses ×7–10 days | 40 mg/kg/day divided | 2 g/day |
Renal Undefined
Hepatic Undefined
Instructions
- Oral use only; not effective for other infection types. Usually not systemically absorbed, but clinically significant serum levels reported with active C. difficile colitis/inflamed intestinal mucosa — consider serum level monitoring (e.g., renal insufficiency, colitis, concomitant aminoglycoside)
Available strengths
- cap 125, 250 mg
- powder 1, 1.25, 5, 10 g/vial
- powder 1.5, 500, 750 mg/vial
- sol 250 mg/5 mL
- sol 25, 50 mg/mL
- inj 500, 750, 1000, 1250, 1500, 1750, 2000, 5000 mg
Cautions
- Not effective for infections other than staphylococcal enterocolitis and C. difficile diarrhea
- Potential for clinically significant systemic absorption (monitor serum levels when appropriate)
- Nephrotoxicity (increased in geriatric patients; monitor renal function)
- Ototoxicity
- Severe dermatologic reactions (discontinue at first rash/mucosal lesion/blisters)
- 125 mg capsule contains FD&C Yellow No. 5 (tartrazine)
Adverse reactions
- Nausea
- Abdominal pain
- Hypokalemia
Pregnancy Low systemic absorption after oral dosing; IV data show no association with adverse outcomes.
Lactation Low oral absorption; unlikely to result in clinically relevant infant exposure.
Cost
Generic entryBy 2023
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Memory aids: interaction avatars
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Self-check
- Does oral vancomycin treat bacteremia?
No. - What dosing approach is preferred over high-trough targeting here?
AUC-guided dosing.