Vancomycin (Vancocin)
Antibiotic | Anti-Infective Agent
Vancomycin is a potent antibiotic used primarily for treating serious Gram-positive infections, including MRSA (methicillin-resistant Staphylococcus aureus). Here are some clinical pearls that pharmacists should be aware of when dealing with vancomycin:
- Therapeutic Monitoring: Vancomycin requires therapeutic drug monitoring to ensure efficacy while avoiding toxicity. Target trough levels typically range from 10-20 µg/mL, depending on the severity and site of the infection.
- Renal Function Monitoring: Vancomycin is nephrotoxic, and monitoring renal function throughout treatment is critical. Adjustments in dosing may be needed based on kidney function (creatinine clearance).
- Infusion-Related Reactions: Rapid infusion can lead to "Red Man Syndrome," a histamine-mediated reaction characterized by flushing and rash primarily on the upper body. To avoid this, vancomycin should be infused over at least one hour, longer for higher doses.
- Dosing Adjustments in Obesity: In obese patients, dosing should be based on actual body weight using a modified dosing strategy to avoid underdosing or overdosing, which could lead to resistance or toxicity, respectively.
- Antibiotic Stewardship: Vancomycin use should be justified and part of an antibiotic stewardship program to prevent resistance. It's vital to use this antibiotic judiciously and ensure it's indicated.
- Compatibility and Stability: Vancomycin can be incompatible with many other drugs in IV solutions. Always check compatibility when administering with other IV medications.
- Ototoxicity: Though less common than nephrotoxicity, ototoxicity can occur, especially with higher-than-recommended serum levels or in combination with other ototoxic drugs. Monitoring for hearing loss is advisable in long-term therapy.
- Administration Route: While commonly administered intravenously for systemic infections, vancomycin can be given orally for specific indications, such as Clostridioides difficile infection, where it is not systemically absorbed.
- Line Lock Therapy: For treating catheter-related bloodstream infections, vancomycin can be used as a line lock, where high concentrations of the drug are instilled into the catheter to eradicate biofilms.
- Penetration Issues: Vancomycin has poor penetration into certain body sites, like the CNS or lungs. In cases of meningitis or severe pneumonia, alternative therapies should be considered if the clinical response is inadequate.
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