Vancomycin

Oral
Clostridioides difficile infection
Adult: 125 mg 6 hourly for 10 days for the 1st episode of non-severe infection; may increase to 500 mg 6 hourly for 10 days for severe or complicated infection. Max: 2,000 mg daily. For multiple recurrences: 125 mg 4 times daily for 10 days followed by either dose tapering (gradually decreasing dose until 125 mg daily) or pulse treatment (125-500 mg every 2-3 days for at least 3 weeks). Dosage recommendations may vary among countries and individual products (refer to specific product guidelines).
Child: <12 years As oral solution: 10 mg/kg 6 hourly for 10 days. Max: 2,000 mg daily. ≥12 years Same as adult dose. Dosage recommendations may vary among countries and individual products (refer to specific product guidelines).
Reconstitution: Oral solution: Using the reconstituted powder for inj (50 mg/mL), extract the appropriate volume for the dose and add 30 mL of water or the diluent provided.
Incompatibility: Incompatible with alkaline solutions. May form precipitates with β-lactam antibiotics.

Oral
Staphylococcal enterocolitis
Adult: 500-2,000 mg in 3-4 divided doses for 7-10 days. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Child: 40 mg/kg in 3-4 divided doses for 7-10 days. Max: 2,000 mg daily. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Reconstitution: Oral solution: Using the reconstituted powder for inj (50 mg/mL), extract the appropriate volume for the dose and add 30 mL of water or the diluent provided.
Incompatibility: Incompatible with alkaline solutions. May form precipitates with β-lactam antibiotics.

Intravenous
Complicated skin and soft tissue infections
Adult: 15-20 mg/kg 8-12 hourly via slow infusion of at least 60 minutes or at Max rate of 10 mg/min (whichever is longer). Max: 2,000 mg/dose. Seriously ill patients: Initially, 25-30 mg/kg to facilitate rapid attainment of the target trough serum vancomycin concentration. Adjust dose according to plasma concentration monitoring. Treatment duration: 7-14 days (non-necrotising); 4-6 weeks (necrotising). Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Child: Term and pre-term neonates' dosage are based on post-menstrual age in weeks, refer to detailed product guidelines. 1 month to <12 years 10-15 mg/kg 6 hourly via slow infusion of at least 60 minutes or at Max rate of 10 mg/min (whichever is longer). ≥12 years Same as adult dose. Treatment duration: 7-14 days (non-necrotising); 4-6 weeks (necrotising). Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Renal impairment: Dosage is individualised based on eGFR values, body weight and serum vancomycin trough levels (refer to detailed product guideline). Maintain initial dose (25-30 mg/kg) for seriously ill patients.
Reconstitution: Solution for infusion: Reconstitute vials labelled as 500 mg and 1,000 mg with 10 mL and 20 mL of sterile water for inj respectively, to make a 50 mg/mL solution. Further dilute the reconstituted solution with a compatible IV solution to a concentration of 5 mg/mL (10 mg/mL in fluid restriction). Refer to specific product guidelines for further instructions on reconstitution.
Incompatibility: Incompatible with alkaline solutions. May form precipitates with β-lactam antibiotics.

Intravenous
Infective endocarditis
Adult: 15-20 mg/kg 8-12 hourly for 4-6 weeks via slow infusion of at least 60 minutes or at Max rate of 10 mg/min (whichever is longer). Max: 2,000 mg/dose. Seriously ill patients: Initially, 25-30 mg/kg to facilitate rapid attainment of the target trough serum vancomycin concentration. Adjust dose according to plasma concentration monitoring. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Child: Term and pre-term neonates' dosage are based on post-menstrual age in weeks, refer to detailed product guidelines. 1 month to <12 years 10-15 mg/kg 6 hourly for 4-6 weeks via slow infusion of at least 60 minutes or at Max rate of 10 mg/min (whichever is longer). ≥12 years Same as adult dose. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Renal impairment: Dosage is individualised based on eGFR values, body weight and serum vancomycin trough levels (refer to detailed product guideline). Maintain initial dose (25-30 mg/kg) for seriously ill patients.
Reconstitution: Solution for infusion: Reconstitute vials labelled as 500 mg and 1,000 mg with 10 mL and 20 mL of sterile water for inj respectively, to make a 50 mg/mL solution. Further dilute the reconstituted solution with a compatible IV solution to a concentration of 5 mg/mL (10 mg/mL in fluid restriction). Refer to specific product guidelines for further instructions on reconstitution.
Incompatibility: Incompatible with alkaline solutions. May form precipitates with β-lactam antibiotics.

Intravenous
Bone and joint infections
Adult: 15-20 mg/kg 8-12 hourly for 4-6 weeks via slow infusion of at least 60 minutes or at Max rate of 10 mg/min (whichever is longer). Max: 2,000 mg/dose. Seriously ill patients: Initially, 25-30 mg/kg to facilitate rapid attainment of the target trough serum vancomycin concentration. Adjust dose according to plasma concentration monitoring. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Child: Term and pre-term neonates' dosage are based on post-menstrual age in weeks, refer to detailed product guidelines. 1 month to <12 years 10-15 mg/kg 6 hourly for 4-6 weeks via slow infusion of at least 60 minutes or at Max rate of 10 mg/min (whichever is longer). ≥12 years Same as adult dose. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Renal impairment: Dosage is individualised based on eGFR values, body weight and serum vancomycin trough levels (refer to detailed product guideline). Maintain initial dose (25-30 mg/kg) for seriously ill patients.
Reconstitution: Solution for infusion: Reconstitute vials labelled as 500 mg and 1,000 mg with 10 mL and 20 mL of sterile water for inj respectively, to make a 50 mg/mL solution. Further dilute the reconstituted solution with a compatible IV solution to a concentration of 5 mg/mL (10 mg/mL in fluid restriction). Refer to specific product guidelines for further instructions on reconstitution.
Incompatibility: Incompatible with alkaline solutions. May form precipitates with β-lactam antibiotics.

Intravenous
Community-acquired pneumonia
Adult: 15-20 mg/kg 8-12 hourly for 7-14 days via slow infusion of at least 60 minutes or at Max rate of 10 mg/min (whichever is longer). Seriously ill patients: Initially, 25-30 mg/kg to facilitate rapid achievement of the target trough serum concentration. Adjust dose according to plasma concentration monitoring. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Child: Term and pre-term neonates' dosage are based on post-menstrual age in weeks, refer to detailed product guidelines. 1 month to <12 years 10-15 mg/kg 6 hourly for 7-14 days via slow infusion of at least 60 minutes or at Max rate of 10 mg/min (whichever is longer). ≥12 years Same as adult dose. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Renal impairment: Dosage is individualised based on eGFR values, body weight, and serum vancomycin trough levels (refer to detailed product guidelines). Maintain initial dose (25-30 mg/kg) for seriously ill patients.
Reconstitution: Solution for infusion: Reconstitute vials labelled as 500 mg and 1,000 mg with 10 mL and 20 mL of sterile water for inj respectively, to make a 50 mg/mL solution. Further dilute the reconstituted solution with a compatible IV solution to a concentration of 5 mg/mL (10 mg/mL in fluid restriction). Refer to specific product guidelines for further instructions on reconstitution.
Incompatibility: Incompatible with alkaline solutions. May form precipitates with β-lactam antibiotics.

Intravenous
Ventilator associated pneumonia
Adult: 15-20 mg/kg 8-12 hourly for 7-14 days via slow infusion of at least 60 minutes or at Max rate of 10 mg/min (whichever is longer). Seriously ill patients: Initially, 25-30 mg/kg to facilitate rapid achievement of the target trough serum concentration. Adjust dose according to plasma concentration monitoring. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Child: Term and pre-term neonates' dosage are based on post-menstrual age in weeks, refer to detailed product guidelines. 1 month to <12 years 10-15 mg/kg 6 hourly for 7-14 days via slow infusion of at least 60 minutes or at Max rate of 10 mg/min (whichever is longer). ≥12 years Same as adult dose. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Renal impairment: Dosage is individualised based on eGFR values, body weight, and serum vancomycin trough levels (refer to detailed product guidelines). Maintain initial dose (25-30 mg/kg) for seriously ill patients.
Reconstitution: Solution for infusion: Reconstitute vials labelled as 500 mg and 1,000 mg with 10 mL and 20 mL of sterile water for inj respectively, to make a 50 mg/mL solution. Further dilute the reconstituted solution with a compatible IV solution to a concentration of 5 mg/mL (10 mg/mL in fluid restriction). Refer to specific product guidelines for further instructions on reconstitution.
Incompatibility: Incompatible with alkaline solutions. May form precipitates with β-lactam antibiotics.

Intravenous
Hospital-acquired pneumonia
Adult: 15-20 mg/kg 8-12 hourly for 7-14 days via slow infusion of at least 60 minutes or at Max rate of 10 mg/min (whichever is longer). Seriously ill patients: Initially, 25-30 mg/kg to facilitate rapid achievement of the target trough serum concentration. Adjust dose according to plasma concentration monitoring. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Child: Term and pre-term neonates' dosage are based on post-menstrual age in weeks, refer to detailed product guidelines. 1 month to <12 years 10-15 mg/kg 6 hourly for 7-14 days via slow infusion of at least 60 minutes or at Max rate of 10 mg/min (whichever is longer). ≥12 years Same as adult dose. Treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Renal impairment: Dosage is individualised based on eGFR values, body weight, and serum vancomycin trough levels (refer to detailed product guidelines). Maintain initial dose (25-30 mg/kg) for seriously ill patients.
Reconstitution: Solution for infusion: Reconstitute vials labelled as 500 mg and 1,000 mg with 10 mL and 20 mL of sterile water for inj respectively, to make a 50 mg/mL solution. Further dilute the reconstituted solution with a compatible IV solution to a concentration of 5 mg/mL (10 mg/mL in fluid restriction). Refer to specific product guidelines for further instructions on reconstitution.
Incompatibility: Incompatible with alkaline solutions. May form precipitates with β-lactam antibiotics.

Intravenous
Prophylaxis of endocarditis
Adult: In patients at high risk of developing bacterial endocarditis when undergoing major surgery: Initially, 15 mg/kg prior to induction of anaesthesia; may repeat dosage depending on the duration of surgery.
Reconstitution: Solution for infusion: Reconstitute vials labelled as 500 mg and 1,000 mg with 10 mL and 20 mL of sterile water for inj respectively, to make a 50 mg/mL solution. Further dilute the reconstituted solution with a compatible IV solution to a concentration of 5 mg/mL (10 mg/mL in fluid restriction). Refer to specific product guidelines for further instructions on reconstitution.
Incompatibility: Incompatible with alkaline solutions. May form precipitates with β-lactam antibiotics.

May be taken with or without food.

Hypersensitivity.

Patient with inflammatory disorders of the intestinal mucosa or Clostridioides difficile-induced pseudomembranous colitis, underlying hearing loss; anuria, allergic reactions to teicoplanin. Oral vancomycin is only indicated for specific types of infection; recommendations may vary among countries, refer to country-specific guidelines. Avoid rapid infusion. Avoid use in patients with previous hearing loss. Renal impairment. Neonates, children, and elderly. Pregnancy and lactation. Monitoring Parameters Perform culture and susceptibility tests; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks. Monitor CBC, LFTs, urine, and serum trough vancomycin concentration periodically. Serial monitoring of renal function and auditory function should be performed. Monitor for signs and symptoms of skin reactions.

Significant: Fungal or bacterial superinfection (prolonged use); transient or permanent ototoxicity, deafness preceded by tinnitus; nephrotoxicity (reversible), may lead to acute renal failure; infusion-related reactions (e.g. hypotension, "red man syndrome", urticaria, pruritus); extravasation (may occur with necrosis), thrombophlebitis; Clostridium difficile associated diarrhoea (IV). Blood and lymphatic system disorders: Neutropenia (reversible), thrombocytopenia. Gastrointestinal disorders: Nausea; abdominal pain, diarrhoea, flatulence, vomiting (oral). General disorders and administration site conditions: Fever, chills, fatigue; peripheral oedema (oral). Metabolism and nutrition disorders: Hypokalaemia (oral). Musculoskeletal and connective tissue disorders: Muscle spasm (chest and back), back pain. Nervous system disorders: Headache. Renal and urinary disorders: UTI. Rarely, interstitial nephritis. Respiratory, thoracic and mediastinal disorders: Dyspnoea, stridor. Vascular disorders: Decrease in blood pressure; vasculitis.
Potentially Fatal: Hypersensitivity reactions, severe cutaneous adverse reactions including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), acute generalised exanthematous pustulosis (AGEP), linear IgA bullous dermatosis (LABD); Clostridium difficile colitis (IV).

Oral: Symptoms: Nausea, vomiting, epigastric discomfort, diarrhoea, and renal insufficiency. Management: Symptomatic and supportive treatment. Perform gastric lavage and administer charcoal in repeated doses. Ensure adequate diuresis. Maintain glomerular filtration.

Increased frequency of erythema, histamine-like flushing, and anaphylactic reactions with anaesthetic agents. May enhance anaesthetic-induced myocardial depression. May reduce the efficacy of oral contraceptives. Concomitant use with other potentially ototoxic, neurotoxic, or nephrotoxic drugs (e.g. aminoglycosides, amphotericin B, polymyxin B, bacitracin, colistin, piperacillin/tazobactam, cisplatin, loop diuretics, NSAIDs) may potentiate the toxicity of vancomycin. Bile acid sequestrants (e.g. colestyramine) may diminish the therapeutic effect of oral vancomycin; administer several hours apart. May enhance the neuromuscular-blocking effect of neuromuscular-blocking agents (e.g. suxamethonium, vecuronium).
Potentially Fatal: May increase the risk of anaphylactic shock with teicoplanin.

Vancomycin is a glycopeptide antibiotic which binds tightly to D-alanyl-D-alanine portion of cell wall precursor, blocking glycopeptide polymerisation leading to the inhibition of bacterial cell wall synthesis. It also impairs bacterial-cell-membrane permeability and RNA synthesis.
Absorption: Poorly absorbed from the gastrointestinal tract. Time to peak plasma concentration: IV: Immediately (after completion of infusion).
Distribution: Distributes widely in the body fluids (except CSF) and tissues. Crosses the placenta and enters breast milk. Volume of distribution: 0.4-1 L/kg. Plasma protein binding: Approx 55%.
Metabolism: No apparent metabolism.
Excretion: IV: Via urine (75% as unchanged drug). Oral: Mainly via faeces. Elimination half-life: 4-6 hours.

Intravenous: Cap and intact vials: Store between 15-25°C. Oral solution kit: Store between 2-8°C. Protect from light. Reconstituted oral solution and solution for infusion: Store between 2-8°C; refer to specific product guidelines for the duration of storage. Do not freeze. Oral: Cap and intact vials: Store between 15-25°C. Oral solution kit: Store between 2-8°C. Protect from light. Reconstituted oral solution and solution for infusion: Store between 2-8°C; refer to specific product guidelines for the duration of storage. Do not freeze.

Other Antibiotics

S01AA28 - vancomycin
A07AA09 - vancomycin ; Belongs to the class of antibiotics. Used in the treatment of intestinal infections.
J01XA01 - vancomycin ; Belongs to the class of glycopeptide antibacterials. Used in the systemic treatment of infections.