vancomycin

Question 1

what is vancomycin used for

Answer 1

it is an antibiotic used for:

• Complicated skin and soft tissue infections
• Clostridium difficile infection
• Community + hospital acquired pneumonia
• Bone + joint infections
• Infective endocarditis
• Acute bacterial meningitis,
• Bacteraemia

Question 2

how should vancomycin be administered for a systemic infection

Answer 2

By intravenous infusion

Vancomycin should NOT to be given by mouth for systemic infection due to lack of absorption

Question 3

what are the contraindications for vancomycin

Answer 3

previous hearing loss with IV use

Question 4

what is the caution for vancomycin use

Answer 4

absorption can be enhanced with inflammatory disorders of intestinal mucosa or with c.difficile-induced pseudomembranous colitis

(increased risk of side effects)

Question 5

can vancomycin be used during pregnancy + breastfeeding

Answer 5

• only to be used in pregnancy if the benefit
  outweighs the risk.
• It is excreted in breastmilk but significant absorption by
  the infant via oral administration is unlikely

Question 6

what monitoring is needed for vancomycin

Answer 6

auditory function, blood count, hepatic and renal function,
leucocyte count (risk of neutropenia or agranulocytosis with long term use)

Question 7

what is the ideal therapeutic range (dose) for vancomycin

Answer 7

10-15mg/L “trough”

initial doses should be based on body-weight; subsequent dose adjustments should be based on serum-vancomycin concentrations to achieve targeted therapeutic concentrations (10-15mg/L trough)

Question 8

why should you avoid rapid infusion of vancomycin

Answer 8

rapid infusion of vancomycin = risk of anaphylactoid reactions (immediate systemic reactions that mimic anaphylaxis )

Question 9

what are the main side effects of vancomycin

Answer 9

• nephrotoxicity
• red man syndrome (a rash on the face, neck, and upper torso)
• neutropenia
• tinnitus (discontinue)
• Agranulocytosis

Question 10

when is the serum-vancomycin normally measured after administration

Answer 10

• on the 2nd day of treatment for all patients if renal function normal
• earlier if impaired renal function

Question 11

what is the initial dose of vancomycin based on

Answer 11

initial doses should be based on body-weight; subsequent dose adjustments should be based on serum-vancomycin concentrations to achieve targeted therapeutic concentrations

Question 12

what are the symptoms of vancomycin toxicity

Answer 12

• red man syndrome
• ototoxicity (discontinue of tinnitus occurs)
• rash
• blood disorders