Vancomycin
VANCOCIN
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.
FDA-approved for
- gram-positive infections (~1958)
FDA label
Read the full label on DailyMed ↗
| 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 systemically absorbed and not effective for other infection types
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.
NO BOXED WARNINGS
Principal riskNephrotoxicity at elevated troughs; infusion reaction
Cost, est. cash$20–$1,500/dose or month
Generic entryBy 2023
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityAllergy, gastrointestinal effects and agent-specific renal, hepatic, hematologic or interaction risks.
Mechanism of action: Vancomycin ballicule
Open Vancomycin in the interactive console ↗
Memory aids: mascots and interaction avatars
purple stain → vancomycin is used to treat Gram-positive bacterial infections
