Vancomycin

Glycopeptide·Infectious Diseases - Glycopeptides

MRSA bacteremia/endocarditis/pneumonia, severe coagulase-negative staph, C. diff colitis (PO)

GLYCOPEPTIDEVancocin125 mgS4TGA

Max Dose

TDM Guided

Half-life

4-6 h

Red Man

INFUSION RATE

Nephrotoxic

HIGH RISK

Rapid Summary

Overview

Massive glycopeptide antibiotic. The heavy artillery for Methicillin-Resistant S. aureus (MRSA) and severe systemic Gram-positive infections.

Maximum Dose

Titrated strictly via Therapeutic Drug Monitoring (TDM). Loading doses often 25-30 mg/kg.

Clinical Focus

Too much kills the kidneys; too little breeds resistance. Trough monitoring is absolutely mandatory.

Bottom Line

Vancomycin is the last-line glycopeptide for MRSA and serious gram-positive infections, but requires therapeutic drug monitoring (trough levels) and carries nephrotoxicity and Red Man Syndrome risk.

Formulation & Access

Brand Names

Vancocin

Oral Routes

Capsules (125 mg, 250 mg). IV powder can be reconstituted and swallowed for C. diff.

Parenteral

Ampoules for IV infusion.

Prescribing & PBS

Hospital supply. Restricted.

Indications & Use

Primary

TGA

MRSA bacteremia/endocarditis/pneumonia, severe coagulase-negative staph, C. diff colitis (PO).

Clinical Place

Empiric choice for suspected MRSA or line-infections. Efficacy relies on 'Area Under the Curve' (AUC) over MIC.

Quick reference

Class & Role

Glycopeptide — Massive glycopeptide antibiotic.

Route / Formulation

Capsules (125 mg, 250 mg). IV powder can be reconstituted and swallowed for C. diff. (Vancocin)

Usual Dose & Max

IV 15-20 mg/kg (actual body weight) q12h. Loading dose of 25-30 mg/kg in critical illness. Titrated strictly via Therapeutic Drug Monitoring (TDM). Loading doses often 25-30 mg/kg.

Key Indication Doses

Severe Systemic MRSA: IV 15-20 mg/kg (actual body weight) q12h. Loading dose of 25-30 mg/kg in critical illness. C. Difficile Colitis: PO 125 mg QID for 10 days. (Oral Vanc is NOT absorbed systemically; it stays in the gut to kill C. diff). Renal Impairment: Dose frequency drastically reduced (e.g., q24h, q48h, or post-dialysis only).

Best Uses

Vancomycin is the last-line glycopeptide for MRSA and serious gram-positive infections, but requires therapeutic drug monitoring (trough levels) and carries nephrotoxicity and Red Man Syndrome risk.

Avoid / Cautions

Previous severe hypersensitivity. Pregnancy Category B2.

Key Risks

Renal: Nephrotoxicity (Acute Tubular Necrosis), especially if trough levels > 20 mg/L or if combined with other nephrotoxins. Immunological: 'Red Man Syndrome' or Vancomycin Infusion Reaction (Flushing, severe hypotension, erythema of face/neck due to massive histamine release). Otic: Ototoxicity (Rare unless combined with aminoglycosides).

Key Interactions

Tazocin (Piperacillin/tazobactam). The combination results in a terrifyingly high rate of Acute Kidney Injury. Monitor creatinine daily. Aminoglycosides, Loop Diuretics, NSAIDs (additive nephrotoxicity).

Monitoring

TDM. Check trough level immediately before the 3rd or 4th dose. Target is usually 15-20 mg/L for severe infections. Daily U&E check. Ensure infusion rate is NEVER faster than 10 mg/minute (e.g., a 1g dose must take at least 100 minutes) to prevent Red Man Syndrome.

Clinical Pearl

If a patient goes bright red, itchy, and hypotensive during infusion, it is rarely true anaphylaxis. It is histamine release from rapid infusion. Stop the pump, give an antihistamine, wait for symptoms to clear, and restart at half the speed.

Access

Vancocin125 mg

Brand: Vancocin
Formulation: Capsules (125 mg, 250 mg)

Vancomycin

Glycopeptide·Infectious Diseases - Glycopeptides

MRSA bacteremia/endocarditis/pneumonia, severe coagulase-negative staph, C. diff colitis (PO)

GLYCOPEPTIDEVancocin125 mgS4TGA

Max Dose

TDM Guided

Half-life

4-6 h

Red Man

INFUSION RATE

Nephrotoxic

HIGH RISK

Rapid Summary

Overview

Massive glycopeptide antibiotic. The heavy artillery for Methicillin-Resistant S. aureus (MRSA) and severe systemic Gram-positive infections.

Maximum Dose

Titrated strictly via Therapeutic Drug Monitoring (TDM). Loading doses often 25-30 mg/kg.

Clinical Focus

Too much kills the kidneys; too little breeds resistance. Trough monitoring is absolutely mandatory.

Bottom Line

Vancomycin is the last-line glycopeptide for MRSA and serious gram-positive infections, but requires therapeutic drug monitoring (trough levels) and carries nephrotoxicity and Red Man Syndrome risk.

Formulation & Access

Brand Names

Vancocin

Oral Routes

Capsules (125 mg, 250 mg). IV powder can be reconstituted and swallowed for C. diff.

Parenteral

Ampoules for IV infusion.

Prescribing & PBS

Hospital supply. Restricted.

Indications & Use

Primary

TGA

MRSA bacteremia/endocarditis/pneumonia, severe coagulase-negative staph, C. diff colitis (PO).

Clinical Place

Empiric choice for suspected MRSA or line-infections. Efficacy relies on 'Area Under the Curve' (AUC) over MIC.

Quick reference

Class & Role

Glycopeptide — Massive glycopeptide antibiotic.

Route / Formulation

Capsules (125 mg, 250 mg). IV powder can be reconstituted and swallowed for C. diff. (Vancocin)

Usual Dose & Max

IV 15-20 mg/kg (actual body weight) q12h. Loading dose of 25-30 mg/kg in critical illness. Titrated strictly via Therapeutic Drug Monitoring (TDM). Loading doses often 25-30 mg/kg.

Key Indication Doses

Best Uses

Vancomycin is the last-line glycopeptide for MRSA and serious gram-positive infections, but requires therapeutic drug monitoring (trough levels) and carries nephrotoxicity and Red Man Syndrome risk.

Avoid / Cautions

Previous severe hypersensitivity. Pregnancy Category B2.

Key Risks

Key Interactions

Monitoring

Clinical Pearl

Access

Vancocin125 mg

Brand: Vancocin
Formulation: Capsules (125 mg, 250 mg)