Vancomycin is used to treat colitis (inflammation of the intestine caused by certain bacteria) that may occur after antibiotic treatment. Vancomycin is in a class of medications called glycopeptide antibiotics. It works by killing bacteria in the intestines. Vancomycin will not kill bacteria or treat infections in any other part of the body when taken by mouth. Antibiotics will not work for colds, flu, or other viral infections.
In subjects with normal kidney function, multiple intravenous dosing of 1 g of vancomycin (15 mg/kg) infused over 60 minutes produces mean plasma concentrations of approximately 63 µg/mL immediately after the completion of infusion, mean plasma concentrations of approximately 23 µg/mL 2 hours after infusion, and mean plasma concentrations of approximately 8 µg/mL 11 hours after the end of the infusion. Multiple dosing of 500 mg infused over 30 minutes produces mean plasma concentrations of about 49 µg/mL at the completion of infusion, mean plasma concentrations of about 19 µg/mL 2 hours after infusion, and mean plasma concentrations of about 10 µg/mL 6 hours after infusion. The plasma concentrations during multiple dosing are similar to those after a single dose.
The mean elimination half-life of Vancomycin from plasma is 4 to 6 hours in subjects with normal renal function. In the first 24 hours, about 75% of an administered dose of Vancomycin is excreted in urine by glomerular filtration. Mean plasma clearance is about 0.058 L/kg/h, and mean renal clearance is about 0.048 L/kg/h. Renal dysfunction slows excretion of vancomycin. In anephric patients, the average half-life of elimination is 7.5 days. The distribution coefficient is from 0.3 to 0.43 L/kg. There is no apparent metabolism of the drug. About 60% of an intraperitoneal dose of Vancomycin administered during peritoneal dialysis is absorbed systemically in 6 hours. Serum concentrations of about 10 µg/mL are achieved by intraperitoneal injection of 30 mg/kg of vancomycin. However, the safety and efficacy of the intraperitoneal use of Vancomycin has not been established in adequate and well-controlled trials (see PRECAUTIONS).
Total systemic and renal clearance of Vancomycin may be reduced in the elderly.
Vancomycin is approximately 55% serum protein bound as measured by ultrafiltration at Vancomycin serum concentrations of 10 to 100 µg/mL. After IV administration of vancomycin, inhibitory concentrations are present in pleural, pericardial, ascitic, and synovial fluids; in urine; in peritoneal dialysis fluid; and in atrial appendage tissue. Vancomycin does not readily diffuse across normal meninges into the spinal fluid; but, when the meninges are inflamed, penetration into the spinal fluid occurs.
Microbiology The bactericidal action of Vancomycin results primarily from inhibition of cell-wall biosynthesis. In addition, vancomycin alters bacterial-cell-membrane permeability and RNA synthesis. There is no cross-resistance between Vancomycin and other antibiotics. Vancomycin is not active in vitro against gram-negative bacilli, mycobacteria, or fungi.
Synergy The combination of Vancomycin and an aminoglycoside acts synergistically in vitro against many strains of Staphylococcus aureus, Streptococcus bovis, enterococci, and the viridans group streptococci.
Vancomycin has been shown to be active against most strains of the following microorganisms, both in vitro and in clinical infections as described in the INDICATIONS AND USAGE section.
Aerobic gram-positive microorganisms Diphtheroids
Enterococci (e.g., Enterococcus faecalis)
Staphylococci, including Staphylococcus aureus and Staphylococcus epidermidis (including heterogeneous methicillin-resistant strains)
Viridans group streptococci
The following in vitro data are available, but their clinical significance is unknown.
Vancomycin exhibits in vitro MIC’s of 1µg/mL or less against most (≥90%) strains of streptococci listed below and MIC’s of 4 µg/mL or less against most (≥90%) strains of other listed microorganisms; however, the safety and effectiveness of Vancomycin in treating clinical infections due to these microorganisms have not been established in adequate and well-controlled clinical trials.
Aerobic gram-positive bacteria (microorganisms) Listeria monocytogenes
Streptococcus pneumoniae (including penicillin-resistant strains)
Anaerobic gram-positive microorganisms Actinomyces species
Dilution Techniques Quantitative methods are used to determine antimicrobial minimum inhibitory concentrations (MIC’s). These MIC’s provide estimates of the susceptibility of bacteria to antimicrobial compounds. The MIC’s should be determined using a standardized procedure. Standardized procedures are based on a dilution method1 (broth or agar) or equivalent with standardized inoculum concentrations and standardized concentrations of Vancomycin powder.
Generic Name: Vancomycin hydrochloride Dosage Form: Injection
See also: * Infections Associated with Lymphedema