Vancomycin

Glycopeptide AntibioticRx: PrescriptionCompound: Approved

Also known as: Firvanq, Lyphocin, VAN, Vancocin, Vancoled

Educational Only — Not medical advice. Consult a qualified clinician before using any peptide.

Summary

Vancomycin is a glycopeptide antibiotic derived from Amycolatopsis orientalis, used primarily for serious infections caused by Gram-positive bacteria including MRSA and Clostridioides difficile. It is considered a last-resort antibiotic for many resistant organisms.

Mechanism of Action

Inhibits bacterial cell wall synthesis by binding to the D-Ala-D-Ala terminus of peptidoglycan precursors, preventing transglycosylation and transpeptidation, leading to cell lysis and death.

Routes of Administration

IntrathecalIntravenousOral

Goals & Uses

  • Treatment of enterococcal infectionsAntimicrobial TherapyHigh
  • Surgical prophylaxis in beta-lactam allergic patientsProphylaxisModerate
  • Treatment of MRSA infectionsAntimicrobialHigh
  • Treatment of Clostridioides difficile colitisAntimicrobial TherapyHigh
  • Treatment of CNS infections (meningitis)Antimicrobial TherapyModerate

Contraindications

  • Severe pre-existing hearing lossOtotoxicity RiskModerate
  • Known hypersensitivity to vancomycinAllergyHigh
  • Vancomycin-resistant organisms (VRE)Microbial ResistanceHigh

Adverse Effects

  • ThrombophlebitisVascularCommon
  • OtotoxicityAuditory/vestibularUncommon
  • HypotensionCardiovascularUncommonLow blood pressure
  • Red man syndromeInfusion ReactionCommon
  • NeutropeniaHematologicUncommonLow neutrophil count
  • NephrotoxicityRenalCommon

Drug Interactions

  • Neuromuscular blocking agentsModerate
  • Aminoglycosides (e.g., gentamicin, tobramycin)High
  • Piperacillin-tazobactamModerate
  • NSAIDs (e.g., indomethacin)Moderate
  • Loop diuretics (e.g., furosemide)Moderate

Population Constraints

  • Pregnancy (Category C/B2)PregnancyRelative
  • Renal impairmentOrgan ImpairmentRelative
  • Elderly patientsAgeRelative
  • Neonates and premature infantsPediatricRelative
  • Hearing-impaired patientsPre Existing ConditionRelative

Regulatory Status

  • European UnionApprovedApproved: Serious Gram-positive infections including MRSA, Clostridioides difficile colitis (oral), Endocarditis and other severe infectionsApproved by EMA member states; available across EU with prescription. Subject to national antimicrobial stewardship programs.
  • United StatesApprovedApproved: Serious infections caused by susceptible Gram-positive bacteria including MRSA, Clostridioides difficile-associated diarrhea and colitis (oral), Enterocolitis caused by Staphylococcus aureus (oral), Endocarditis, Bone and joint infectionsFDA-approved since 1958. IV and oral formulations approved. AUC/MIC-guided TDM recommended per ASHP/IDSA/SIDP guidelines (2020).
  • United KingdomApprovedApproved: Serious Gram-positive bacterial infections, MRSA infections, Clostridioides difficile infection (oral)Approved by MHRA. Listed as a WHO Essential Medicine. Subject to antimicrobial stewardship guidelines from PHE/UKHSA.

FDA-approved since 1958. Subject to therapeutic drug monitoring (TDM) due to narrow therapeutic index. Oral formulation approved specifically for C. difficile colitis; IV formulation for systemic infections.

Evidence & Sources

No sources recorded yet.

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