Vancomycin Hydrochloride for Intravenous Infusion

Generic Name:
Product Name: Vancomycin Hydrochloride for Intravenous Infusion

Indication

Vancomycin Hydrochloride for Intravenous Infusion is used for the treatment of potentially life threatening infections that cannot be treated with another, less toxic antibiotic (eg: penicillins, cephalosporins).

Staphylococcal infectionsIt is used against serious Staphylococcal infections (including MRSA) when treatment with other antibiotics has failed or the strain has been shown to be resistant. Sites of infection include:

• bone infection
• pneumonia
• blood infection
• soft tissue and skin infections

If an abscess has formed in relation to the infection, antibiotic treatment should be used only in support of surgical drainage.

Heart valve infection (endocarditis)

• Vancomycin is used alone or in combination with an aminoglycoside for the treatment of endocarditis caused by Streptococcus viridans or S. bovis.
• Endocarditis caused by Enterococcus species can only be treated with Vancomycin when it is combined with an aminoglycoside.
• When endocarditis is caused by Staphylococcus epidermidis the combination of Vancomycin and rifampicin is appropriate.

Infective diarrhoea (colitis)

• Vancomycin Hydrochloride for Intravenous Infusion should not be used to treat Staphylococcal colitis or pseudomembranous colitis caused by Clostridium difficile. Vancomycin is appropriate in these settings, but the oral preparation should be used (eg: Vancocin capsules). If absolutely necessary, the IV preparation can be given orally, but capsules should be used in preference.

Action

Vancomycin is from the class of antibiotics known as glycopeptides. It is active against Gram-positive bacteria, but no activity against Gram-negative bacteria, mycobacteria or fungi. It acts by inhibiting the production of a protein needed by bacteria to build their cell walls. Without this component, bacteria cannot survive. This is a similar mechanism of action to the penicillin antibiotics, but Vancomycin acts at a different site and is therefore active against several bacteria that may be resistant to penicillin (eg: S. pneumoniae). Vancomycin is active against a large list of common and uncommon Gram-positive bacteria, including:

• Staphylococcus aureus (otherwise known as Golden Staph) including the very resistant strains, MRSA
• Streptococci, including Streptococcus pneumoniae, which is an important cause of pneumonia
• Enterococcus faecalis
• Clostridium difficile, a normal bowel bug that can sometimes overgrow during treatment with other antibiotics and cause very serious diarrhoea
• Many other bacteria

When used in combination with other antibiotics, Vancomycin can have stronger actions against certain bacteria. For example, when used in combination with aminoglycosides (eg: gentamicin) it has stronger action against S. aureus.

The Vancomycin + rifampicin combination also has stronger activity against many S. aureus strains.

As with treating all infections, it is important to determine the causative organism and susceptibilities before initiating treatment if possible.

Dose advice

Vancomycin Hydrochloride for Intravenous Infusion is for intravenous use only. It should not be used intramuscularly. 1 500mg vial should be mixed with 10ml water for injection. The 1g vial should be mixed with 20ml water for injection. Further dilute with 100ml sodium chloride 0.9% or glucose 5% (200ml for 1g vial) and infuse at a rate of no less than 1hr per 500mg. Less dilution may be used in patients on fluid restriction, but infusion related events increase with any degree of concentration.

The reconstituted solution (in water for injection only) may be stored at 2-8?aC for up to 96 hours, while the further diluted solution is stable for 28 days at this temperature. Despite this stability, solutions of Vancomycin should be used within 24 hours to reduce microbiological hazard.

Adults

• 500mg every six hours; or 1g every 12 hours
• 500mg dose should be infused over no less than 60 minutes

Adults with impaired renal function and the elderly

Dosage adjustment must be made according to creatinine clearance, with the Vancomycin dose being about 15 times the creatinine clearance, for example:

• creatinine clearance 100ml/min: Vancomycin dose, 1,545mg/24hours
• 80ml/min: 1,235mg/24hours
• 50ml/min: 770mg/24hours
• 20ml/min: 310mg/24hours

Children

• 10mg/kg every six hours
• ensure each dose is administered over no less than 60 minutes

Neonates and infants

• 10mg/kg every 12 hours (first week of life) or every 8 hours (until one month of age)
• administer every dose over no less than 60 minutes
• serum Vancomycin concentration monitoring is essential in these patients

Loading dose

• in all patients (including children, neonates and infants) the initial dose should be no less than 15mg/kg, even in patients with renal impairment

Duration of therapy

• most infections show some response to Vancomycin within 48-72hours, but duration of therapy ultimately depends on severity and type of infection
• at least three weeks of treatment is required for the treatment of staphylococcal endocarditis

Oral treatment for colitis

• oral Vancomycin preparations such as Vancocin capsules are preferred for treatment of colitis, but the IV preparation can be used
• 1 vial (500mg) should be diluted in 30ml of distilled water (with flavouring if desired) and given to the patient to drink or administered via nasogastric tube if necessary

Schedule

S4

Common side effects

Inflammation of the vein used for infusion may be experienced with use of Vancomycin, with such symptoms as:

• itching
• redness
• swelling

This can be reduced if the site of infusion is regularly changed.

Vancomycin has a very bad taste if taken orally, it can be flavoured with sweet syrups if desired.

Uncommon side effects

• Injection-related reactions are seen with rapid infusion of Vancomycin
• Serious adverse effects may result such as: exaggeration of hypotension, shock, cardiac arrest
• Flushing, hives and red and itching skin may also be seen
• Patients with leukaemia being treated with Vancomycin may experience nausea, diarrhoea and less often, vomiting.

For further information talk to your doctor.