vancomycin

introduction

an amphoteric glycopeptide antimicrobial substance produced by the growth of certain strains of Nocardia orientalis.
bactericidal against many Gram positive organisms including MRSA Staph. aureus
Gram negative bacteria, mycobacteria and fungi are resistant.
most hospitals require doctors seek authority prior to prescribing this restricted antibiotic.
category B2 in pregnancy
is excreted in breast milk but it is not known whether it is harmful to the newborn infant.
use in premature neonates, infants and children, it is appropriate to confirm vancomycin serum concentrations.
concomitant administration of vancomycin and anaesthetic agents has been associated with erythema and histamine-like flushing in children
may enhance neuromuscular blockade produced by medicines such as suxamethonium or vecuronium

infusion-related events from rapid infusion
sensorineural deafness which may be accompanied by tinnitus
- diuretics such as ethacrynic acid and frusemide may aggravate ototoxicity
reversible neutropenia
hypersensitivity reactions
rarely, interstitial nephritis - usually when given with concomitant aminoglycoside antibiotics or with pre-existing renal impairment.

initial loading dose 15mg/kg, even in patients with mild to moderate renal insufficiency
usual maintenance intravenous dose is 10mg/kg to max. 500 mg infused over at least 60minutes every six hours or 1 g infused over at least 120 minutes every 12 hours.
neonates and young infants, the total daily intravenous dosage may be lower. An initial dose of 15 mg/kg is suggested, followed by 10 mg/kg over 60 minutes every 12 hours in the first week of life and every eight hours thereafter until one month of age. Close monitoring of serum vancomycin concentrations is mandatory in these patients.
see PI for dose in elderly, renal impairment,

with the exception of the Loading Dose, ALL subsequent dosing intervals of Vancomycin are to be based upon serum blood levels
NOTE: THERE IS NO MAXIMUM DOSAGE FOR VANCOMYCIN

patients on High-Flux haemodialysis have 30% or greater removal of Vancomycin during dialysis due to the high-flux membrane.
if the pre-dialysis vancomycin level is ≤25 mg/L then the next dose of Vancomycin should be administered during that dialysis treatment
administer these doses during High-Flux dialysis session
the dose and rate must be known so that the time of commencing the administration of Vancomycin is identified, thereby enabling the completion of administration to coincide with the completion of dialysis.
initial dose 30mg/kg
maintenance doses 25mg/kg

includes:
- patients on High Flux dialysis but who are not currently having a dialysis session
- Low Flux dialysis
- peritoneal dialysis
initial dose 25mg/kg
maintenance dose 20mg/kg
when the pre-dialysis Vancomycin level is ≤20 mg/L a further dose should be administered that day
if the pre-dialysis level is ≤15 mg/L then an interval reduction before the next dose is required.

MAXIMUM RATE of administration 16.6mg/min or 500mg over 30 mins or 1 gram over 1 hour UNLESS administration DURING High Flux dialysis, in which case, maximum rate is 25mg per minute (ie 750mg over 30 mins, or 1.5 g over 1hour)

at a MINIMUM all dialysis patients on Vancomycin should have a level taken before each dialysis run.
increased frequency of Vancomycin levels may be indicated and are at the discretion of the treating Renal or Infectious Disease Unit
if levels are taken after dialysis, delay venepuncture until 6 hours following the end of the dialysis session.
patients on peritoneal dialysis should have levels taken daily, immediately pre-dose until dosing and levels

are stable.