Skip to content
Chapters

Part III: Guidelines for Selected Antimicrobial Use



3.1 Vancomycin



  1. The first glycopeptide antibiotic against Gram-positive bacteria by inhibiting cell wall synthesis.

  2. Vancomycin can be used to treat serious infections caused by β-lactam resistant Gram-positive bacteria, e.g. MRSA, coagulase-negative staphylococci.

  3. When administered orally, it can be used for Clostridioides difficile-associated diarrhoea or colitis. [133]

  4. Intravenous dosing for adult patients weighing 50 kg [134–136]

Loading dose: 1 g

Infuse each dose over 2 hours to minimise the risk of ‘vancomycin infusion reaction’ (formerly known as ‘Red Man syndrome’) [137,138]

Maintenance dose for adults weighing 50 kg with normal renal function:

1 g every 12 hours administered as an intermittent infusion, assuming a vancomycin MIC of 1 microgram/mL or below

Maintenance dose for adults weighing 50 kg with renal impairment:

Based on creatinine clearance (CrCl) when it can be accurately measured or estimated (note: NOT applicable for functionally anephric patients, including patients requiring dialysis): [135,139]

CrCl >50–100 mL/min: 1 g every 12 hours

CrCl 20–49 mL/min: 1 g every 24–48 hours

CrCl <20 mL/min: 1 g every 4–5 days

Clinical circumstances can differ; please review frequently and adjust as needed. [140]

  1. Vancomycin has a narrow therapeutic index with nephrotoxicity risk increases with serum trough level, particularly when exceeding 15 mg/L1. [141–150]

  1. Therapeutic drug monitoring of vancomycin remains a subject of ongoing debate, with controversies surrounding the ideal target exposure and monitoring approach. [134,146,147,151–154]

  2. Vancomycin dosing should be customised based on individual clinical circumstances. Key factors to consider include patient-specific factors, site and severity of infection, and vancomycin MIC of the target organism.

  3. Adverse reactions (non-exhaustive)

Dose-dependent nephrotoxicity

Vancomycin infusion reaction

Drug fever

Neutropaenia and thrombocytopaenia

Drug reaction with eosinophilia and systemic symptoms (DRESS) [155]

  1. If there is any uncertainty, please consult a clinical microbiologist or infectious disease physician for the use of vancomycin.



Footnotes

  1. The measurement unit mg/L (milligram per liter) is equivalent to microgram/mL (microgram per milliliter).↩︎

Previous Page
Next Page