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{{Vancomycin}}
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'''''For patient information, click <u>[[Vancomycin Hydrochloride Injection (patient information)|here]]'''''</u>.
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|adverseReactions=<!--Black Box Warning-->
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{{CMG}}; {{AE}} {{AK}}
* Content


==Overview==
<!--Adult Indications and Dosage-->
[[Image:Vancomysin AntimicrobAgentsChemother 1990 1342.jpg|thumbnail|300px|Crystal structure of a short peptide L-Lys-D-Ala-D-Ala (bacterial cell wall precursor, in green) bound to vancomycin (blue) through hydrogen bonds. Reported by Knox and Pratt in Antimicrob. Agents. Chemother., 1990 1342-1347]]
'''Vancomycin''' ([[International Nonproprietary Name|INN]]) ({{pronEng|ˌvæŋkoʊˈmaɪs<s>ɪ</s>n}}) is a [[glycopeptide]] [[antibiotic]] used in the [[prophylaxis]] and treatment of infections caused by [[Gram-positive]] [[bacterium|bacteria]]. It has traditionally been reserved as a [[drug of last resort|drug of "last resort"]], used only after treatment with other antibiotics had failed, although the emergence of vancomycin-resistant organisms means that it is increasingly being displaced from this role by [[linezolid]] and the [[carbapenem]]s.
==History==
Vancomycin was first isolated by [[EC Kornfeld]] (working at [[Eli Lilly and Company|Eli Lilly]]) from a soil sample collected from the interior jungles of [[Borneo]] by a missionary.  The organism that produced it was eventually named ''[[Amycolatopsis orientalis]]''.<ref> {{cite journal|author=Levine DP|title=Vancomycin: a history|journal=Clin Infect Dis|year=2006|volume=42|issue=Suppl 1|pages=S5&ndash;12|doi=10.1086/491709}}</ref> The original indication for vancomycin was for the treatment of [[penicillin]]-resistant ''[[Staphylococcus aureus]]''.<ref name="Moellering2006">{{cite journal | author=Moellering, RC Jr. | title=Vancomycin: A 50-Year Reassessment | journal=Clin Infect Dis | year=2006 | volume=42 | pages=S3&ndash;S4 | pmid=16323117 }}</ref><ref name="Levine2006">{{cite journal | author=Donald P. | title=Vancomycin: A History | journal=Clin Infect Dis | year=2006 | volume=42| pages=S5-S12 | pmid=16323120 }}</ref>


The compound was initially labelled '''compound 05865''', but was eventually given the generic name, '''vancomycin''' (derived from the word "vanquished").  One advantage that was quickly apparent was that staphylococci did not develop significant resistance despite serial passage in culture media containing vancomycin.  The rapid development of [[penicillin]]-resistance by staphylococci led to the compound being fast-tracked for approval by the [[Food and Drug Administration|FDA]] in [[1958]].  Eli Lilly first marketed vancomycin hydrochloride under the trade name '''Vancocin'''.<ref name="Moellering2006"/>
<!--FDA-Labeled Indications and Dosage (Adult)-->
|fdaLIADAdult======Condition1=====


Vancomycin never became first line treatment for ''Staphylococcus aureus'' for several reasons:
* Dosing Information
#The drug must be given [[intravenous]]ly, because it is not absorbed orally.
#β-lactamase-resistant semi-synthetic penicillins such as [[methicillin]] (and its successors, [[nafcillin]] and [[cloxacillin]]) were subsequently developed.
#Early trials using early impure forms of vancomycin ("Mississippi mud") which were found to be toxic to the ears and to the kidneys;<ref name="Griffiths1981">{{cite journal | author=Griffith RS. | title=Introduction to vancomycin | journal=Rev Infect Dis | year=1981 | volume=3 | pages=S2004 }}</ref> these findings led to vancomycin being relegated to the position of a drug of last resort.


In 2004, [[Eli Lilly and Company|Eli Lilly]] licensed ''Vancocin'' to [[ViroPharma]] in the U.S., [[Flynn Pharma]] in the UK and [[Aspen Pharmacare]] in Australia.  The [[patent]] expired in the early [[1980s]] and generic versions of the drug are also available under various trade names.
:* Dosage


==Pharmacology and chemistry==
=====Condition2=====
It is a branched [[Wiktionary:tricyclic|tricyclic]] [[Glycosylation|glycosylated]] [[nonribosomal peptide]] produced by the [[fermentation (biochemistry)|fermentation]] of the [[Actinobacteria]] species ''[[Amycolatopsis|Amycolatopsis orientalis]]'' (formerly designated ''Nocardia orientalis'').


Vancomycin acts by inhibiting proper [[cell wall]] synthesis in Gram-positive bacteria. The mechanism inhibited, and various factors related to entering the outer membrane of [[Gram-negative]] organisms mean that vancomycin is not active against Gram-negative bacteria (except some non-gonococcal species of [[Neisseria]]).
* Dosing Information


Specifically, vancomycin prevents incorporation of N-acetylmuramic acid (NAM)- and N-acetylglucosamine (NAG)-peptide subunits into the [[peptidoglycan]] matrix; which forms the major structural component of Gram-positive cell walls.
:* Dosage


The large [[hydrophilic]] molecule is able to form [[hydrogen bond]] interactions with the terminal D-alanyl-D-alanine moieties of the NAM/NAG-peptides. Normally this is a five-point interaction. This binding of vancomycin to the D-Ala-D-Ala prevents the incorporation of the NAM/NAG-peptide subunits into the peptidoglycan matrix.
=====Condition3=====


Vancomycin exhibits [[atropisomer]]ism — it has two chemically distinct [[rotamer]]s owing to the rotational restriction of the chlorotyrosine residue (on the right hand side of the figure). The form present in the drug is the thermodynamically more stable [[conformer]], and, importantly, has more potent activity.
* Dosing Information


Vancomycin can be given orally, but this method is very expensive.  It may also be used in treatment for [[clostridium difficile]].
:* Dosage


==Clinical use==
=====Condition4=====
===Indications===
Vancomycin is indicated for the treatment of serious, life-threatening infections by [[Gram-positive]] bacteria which are unresponsive to other less toxic antibiotics.  In particular, vancomycin should not be used to treat methicillin-sensitive [[Staphylococcus aureus]] because it is inferior to penicillins such as [[nafcillin]].<ref>{{cite journal|author=Small PM, Chambers HF|title=Vancomycin for ''Staphylococcus aureus'' endocarditis in intravenous drug users|journal=Antimicrob Agents Chemother|year=1990|volume=34|pages=1227&ndash;31|pmid=2393284}}</ref><ref>{{cite journal|author=Gonzalez C, Rubio M, Romero-Vivas J, Gonzalez M, Picazo JJ|title=Bacteremic pneumonia due to ''Staphylococcus aureus'': a comparison of disease caused by methicillin-resistant and methicillin-susceptible organisms|journal=Clin Infect Dis|year=1999|volume=29|pages=1171&ndash;7|pmid=10524959|doi=10.1086/313440}}</ref>


The increasing emergence of vancomycin-resistant [[enterococcus|enterococci]] has resulted in the development of guidelines for use by the [[Centers for Disease Control]] (CDC) Hospital Infection Control Practices Advisory Committee. These guidelines restrict use of vancomycin to the following indications:<ref name="AMH2006">Rossi S, editor. [[Australian Medicines Handbook]] 2006. Adelaide: Australian Medicines Handbook; 2006. ISBN 0-9757919-2-3</ref>
* Dosing Information
*treatment of serious infections caused by susceptible organisms resistant to [[penicillin]]s ([[methicillin-resistant Staphylococcus aureus|methicillin-resistant ''Staphylococcus aureus'']] and multi-resistant ''[[Staphylococcus epidermidis]]'' (MRSE)) or in individuals with serious allergy to [[penicillin]]s
*[[pseudomembranous colitis]] (relapse or unresponsive to [[metronidazole]] treatment)
*For treatment of infections caused by gram-positive microorganisms in patients who have serious allergies to beta-lactam antimicrobials. (http://wonder.cdc.gov/wonder/prevguid/m0039349/m0039349.asp)
*antibacterial prophylaxis for [[endocarditis]] following certain procedures in penicillin-[[hypersensitivity|hypersensitive]] individuals at high risk
*surgical prophylaxis for major procedures involving implantation of [[prosthesis|prostheses]] in institutions with a high rate of MRSA or MRSE


===Adverse effects===
:* Dosage
Common [[adverse drug reaction]]s (≥1% of patients) associated with IV vancomycin include: local pain, which may be severe and/or [[thrombophlebitis]].


Damage to the kidneys and to the hearing were a side effect of the early impure versions of vancomycin, and these were prominent in the clinical trials conducted in the mid-1950s.  Later trials using purer forms of vancomycin found that [[nephrotoxicity]] is an infrequent adverse effect (0.1–1% of patients), but that this is accentuated in the presence of [[aminoglycoside]]s.<ref>{{cite journal | author=Farber BF, Moellering RC Jr. | title=Retrospective study of the toxicity of preparations of vancomycin from 1974 to 1981. | journal=Antimicrob Agents Chemother | year=1983 | volume=23 | pages=138 }}</ref>
<!--Off-Label Use and Dosage (Adult)-->


Rare adverse effects (<0.1% of patients) include: [[anaphylaxis]], [[toxic epidermal necrolysis]], [[erythema multiforme]], red man syndrome (''[[Vancomycin#Red man syndrome|see below]]''), [[superinfection]], [[thrombocytopenia]], [[neutropenia]], [[leukopenia|leucopenia]], [[tinnitus]], dizziness and/or ototoxicity (''[[Vancomycin#Ototoxicity|see below]]'').<ref name="AMH2006" />
<!--Guideline-Supported Use (Adult)-->
|offLabelAdultGuideSupport======Condition1=====


Lately it has been emphasized that vancomycin can induce platelet-reactive antibodies in the patient, leading to severe [[thrombocytopenia]] and bleeding with florid [[petechial hemorrhages]], [[ecchymoses]], and [[wet purpura]]. <ref>{{cite journal | author=Drygalski A, Curtis BR | title=Vancomycin-Induced Immune Thrombocytopenia | journal= N Engl J Med | year=2007 | volume=356 | pages=904  | doi=10.1056/NEJMoa065066}}</ref>
* Developed by:


===Dosing considerations===
* Class of Recommendation:
====Intravenous vs oral administration====
Vancomycin needs to be given [[intravenous]]ly (IV) for systemic therapy since it does not cross through the intestinal lining. It is a large hydrophilic molecule which partitions poorly across the gastrointestinal [[mucosa]]. The only indication for oral vancomycin therapy is in the treatment of [[pseudomembranous colitis]], where it must be given orally to reach the site of infection in the colon.  Inhaled vancomycin has also been used ([[off-label]]), via [[nebulizer]], for treatment of various infections of the upper and lower respiratory tract.


====Red man syndrome====<!-- This section is linked from [[Vancomycin]] -->
* Strength of Evidence:  
* [[Vancomycin]] must be administered in a dilute solution slowly, over at least 60 minutes (maximum rate of 10 mg/minute for doses >500 mg).<ref name="AMH2006" />
* This is due to the high incidence of [[pain]] and [[thrombophlebitis]] and to avoid an infusion reaction known as the '''red man syndrome''' or '''red neck syndrome'''.
* This syndrome, usually appearing within 4–10 minutes after the commencement or soon after the completion of an infusion, is characterised by flushing and/or and an [[erythematous]] rash that affects the face, neck and upper torso.
*  Less frequently, [[hypotension]] and [[angioedema]] may also occur.
* Symptoms may be treated with [[antihistamine]]s, including [[diphenhydramine]].<ref name="Sivagnanam2003">Sivagnanam S, Deleu D. Red man syndrome. Crit Care 2003;7(2):119–120. PMID 12720556. ([http://www.pubmedcentral.gov/articlerender.fcgi?tool=pubmed&pubmedid=12720556 full text])</ref>
===Vancomycin target troughs===
* While treating a patient with vancomycin a target trough of at least 10 mcg/mL should be achieved. This is important due to the following:
* Decreases the risk of microbes with elevated vancomycin minimum inhibitory concentrations (MICs).
* Microbes with elevated MICs towards vancomycin have shown decreased susceptibility to other antimicrobials agents such as [[daptomycin]]. Thus, maintaining a trough of atleast 10 mcg/mL helps in avoiding development of resistance to other microbes too.
* The vancomycin target trough in invasive infections like bacteremia, endocarditis, osteomyelitis, prosthetic joint infections, hospital acquired pneumonia, and central nervous system infections is usually kept between 15 to 20 mcg/mL.


===Therapeutic drug monitoring===
* Dosing Information
Vancomycin activity is considered to be time-dependent – that is, antimicrobial activity depends on the duration that the drug level exceeds the [[minimum inhibitory concentration]] (MIC) of the target organism. Thus, peak levels have not been shown to correlate with efficacy or toxicity – indeed concentration monitoring is unnecessary in most cases. Circumstances where [[therapeutic drug monitoring]] (TDM) is warranted include: patients receiving concomitant aminoglycoside therapy, patients with (potentially) altered [[pharmacokinetics|pharmacokinetic]] parameters, patients on [[hemodialysis|haemodialysis]], during high dose or prolonged treatment, and patients with impaired renal function. In such cases, trough concentrations are measured.<ref name="AMH2006" /><ref name="Cantu1994">Cantu TG, Yamanaka-Yuen NA, Lietman PS. Serum vancomycin concentrations: reappraisal of their clinical value. Clin Infect Dis 1994;19(6):1180-2. PMID 8038306</ref><ref name="Moellering1994">Moellering RC Jr. Monitoring serum vancomycin levels: climbing the mountain because it is there? Clin Infect Dis 1994;18(4):544-6. PMID 8038307</ref><ref name="Karam1999"> Karam CM, McKinnon PS, Neuhauser MM, Rybak MJ. Outcome assessment of minimizing vancomycin monitoring and dosing adjustments. Pharmacotherapy 1999;19(3):257-66. PMID 10221365</ref>


==Toxicity==
:* Dosage
Vancomycin has traditionally been considered a [[nephrotoxic]] and [[ototoxic]] drug, based on observations by early investigators of elevated serum levels in renally impaired patients who had experienced ototoxicity, and subsequently through case reports in the medical literature. However, as the use of vancomycin increased with the spread of [[MRSA]] beginning in the seventies, it was recognised that the previously reported rates of toxicity were not being observed. This was attributed to the removal of the impurities present in the earlier formulation of the drug, although those impurities were not specifically tested for toxicity.<ref name="Levine2006"/>


===Nephrotoxicity===
=====Condition2=====
Subsequent reviews of accumulated case reports of vancomycin-related [[nephrotoxicity]] found that many of the patients had also received other known nephrotoxins, particularly [[aminoglycosides]]. Most of the rest had other confounding factors, or insufficient data regarding the possibility of such, that prohibited the clear association of vancomycin with the observed renal dysfunction.


In 1994, Cantu and colleagues found that the use of vancomycin monotherapy was clearly documented in only three of 82 available cases in the literature.<ref name="Cantu1994" /> Prospective and retrospective studies attempting to evaluate the incidence of vancomycin-related nephrotoxicity have largely been methodologically flawed and have produced variable results. The most methodologically sound investigations indicate that the actual incidence of vancomycin-induced nephrotoxicity is around 5–7%. To put this into context, similar rates of renal dysfunction have been reported for [[cefamandole]] and [[benzylpenicillin]], two reputedly non-nephrotoxic antibiotics.  
There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of {{PAGENAME}} in adult patients.


Additionally, evidence to relate nephrotoxicity to vancomycin serum levels is inconsistent. Some studies have indicated an increased rate of nephrotoxicity when trough levels exceed 10 µg/mL, but others have not reproduced these results. Nephrotoxicity has also been observed with concentrations within the "therapeutic" range as well. Essentially, the reputation of vancomycin as a nephrotoxin is over-stated, and it has not been demonstrated that maintaining vancomycin serum levels within certain ranges will prevent its nephrotoxic effects, when they do occur.
<!--Non–Guideline-Supported Use (Adult)-->
|offLabelAdultNoGuideSupport======Condition1=====


===Ototoxicity===<!-- This section is linked from [[Vancomycin]] -->
* Dosing Information
Attempts to establish rates of vancomycin-induced ototoxicity are even more difficult due to the scarcity of quality evidence. The current consensus is that clearly related cases of vancomycin ototoxicity are rare. The association between vancomycin serum levels and ototoxicity is also uncertain. While cases of ototoxicity have been reported in patients whose vancomycin serum level exceeded 80 µg/mL, cases have been reported in patients with therapeutic levels as well. Thus, it also remains unproven that [[therapeutic drug monitoring]] of vancomycin for the purpose of maintaining "therapeutic" levels will prevent ototoxicity.


===Interactions with other nephrotoxins===
:* Dosage
Another area of controversy and uncertainty concerns the question of whether, and if so, to what extent, vancomycin increases the toxicity of other nephrotoxins. Clinical studies have yielded variable results, but animal models indicate that there probably is some increased nephrotoxic effect when vancomycin is added to nephrotoxins such as aminoglycosides. However, a dose- or serum level-effect relationship has not been established.


==Antibiotic resistance==
=====Condition2=====
===Intrinsic resistance===
There are a few [[gram-positive]] bacteria that are intrinsically resistant to vancomycin: these are [[Leuconostoc]] and [[Pediococcus]] species, but these organisms are rare causes of disease in humans.<ref name="Swenson1990">{{cite journal | author=Swenson JM, Facklam RR, Thornsberry C | title=Antimicrobial susceptibility of vancomycin-resistant ''Leuconostoc, Pediococcus'' and ''Lactobacillus'' species | journal=Antimicrob Agents Chemother | year=1990 | volume=34 | pages=543&ndash;49 }}</ref>  Most [[Lactobacillus]] species are also intrinsically resistant to vancomycin<ref name="Swenson1990"/> (the exception is the finding of a few strains (but not all) of ''[[Lactobacillus acidophilus|L. acidophilus]]''<ref>{{cite journal | author=Hamilton-Miller JM, Shah S | year=1998 | title=Vancomycin susceptibility as an aid to the identification of lactobacilli | journal=Lett Appl Microbiol | year=1998 | volume=26 | pages=153&ndash;54  | doi=10.1046/j.1472-765X.1998.00297.x}}</ref>).


Most [[gram-negative]] bacteria are intrinsically resistant to vancomycin because of their outer membrane is impermeable to large glycopeptide molecules<ref>{{cite book | author=Quintiliani R Jr, Courvalin P | chapter=Mechanisms of Resistance to Antimicrobial Agents | title=Manual of Clinical Microbiology | editor=Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH | publisher=ASM Press | location=Washington DC | year=1995 | edition=6th | pages=1319 | isbn=1-55581-086-1 }}</ref> (with the exception of some non-gonococcal [[Neisseria]] species).<ref>{{cite journal | author=Geraci JE, Wilson WR | title=Vancomycin therapy for infective enocarditis | journal=Rev Infect Dis | year=1981 | volume=3(Suppl) | pages=S250&ndash;58 }}</ref>
There is limited information regarding <i>Off-Label Non–Guideline-Supported Use</i> of {{PAGENAME}} in adult patients.


===Acquired resistance===
<!--Pediatric Indications and Dosage-->
Acquired microbial [[antibiotic resistance|resistance]] to vancomycin is a growing problem, particularly within health care facilities such as hospitals. With vancomycin being the last-line antibiotic for serious [[Gram-positive]] infections there is the growing prospect that resistance will result in a return to the days when fatal bacterial infections were common.


[[Vancomycin-resistant enterococcus]] (VRE) emerged in [[1987]]. Vancomycin resistance emerged in more common pathogenic organisms during the [[1990s]] and [[2000s]], including [[vancomycin-resistant Staphylococcus aureus|vancomycin-intermediate ''Staphylococcus aureus'']] (VISA), [[vancomycin-resistant Staphylococcus aureus|vancomycin-resistant ''Staphylococcus aureus'']] (VRSA), and vancomycin-resistant ''[[Clostridium difficile]]''.<ref name="Smith1999">Smith TL, Pearson ML, Wilcox KR, Cruz C, Lancaster MV, Robinson-Dunn B, et al. Emergence of vancomycin resistance in Staphylococcus aureus. Glycopeptide-Intermediate Staphylococcus aureus Working Group. [[New England Journal of Medicine|N Engl J Med]] 1999;340(7):493-501. PMID 10021469</ref><ref name="McDonald2005">McDonald LC, Killgore GE, Thompson A, et al. Emergence of an epidemic, toxin gene variant strain of Clostridium difficile responsible for outbreaks in the United States between 2000 and 2004. N Engl J Med 2005;353:2433-2441. PMID 16322603</ref> There is some suspicion that agricultural use of [[avoparcin]], another similar glycopeptide antibiotic, has contributed to the emergence of vancomycin-resistant organisms.
<!--FDA-Labeled Indications and Dosage (Pediatric)-->
|fdaLIADPed======Condition1=====


One mechanism of resistance to vancomycin appears to be alteration to the terminal [[amino acid]] residues of the NAM/NAG-peptide subunits, normally D-alanyl-D-alanine, which vancomycin binds to. Variations such as D-alanyl-D-lactate and D-alanyl-D-serine result in only a 4-point hydrogen bonding interaction being possible between vancomycin and the peptide. This loss of just one point of interaction results in a 1000-fold decrease in affinity.
* Dosing Information


In ''Enterococci'' this modification appears to be due to the expression of an enzyme which alters the terminal residue. Three main resistance variants have been characterised to date among resistant ''Enterococcus faecium'' and ''E. faecalis'' populations.
:* Dosage
*VanA - resistance to vancomycin and [[teicoplanin]], inducible on exposure to these agents
*VanB - lower level resistance, inducible by vancomycin but strains may remain susceptible to teicoplanin
*VanC - least clinically important, resistance only to vancomycin, constitutive resistance


The development and use of novel antibiotics such as [[linezolid]] and [[daptomycin]] is expected to delay, but not halt, the emergence of bacteria resistant to all available antibiotics.
=====Condition2=====


==References==
There is limited information regarding <i>FDA-Labeled Use</i> of {{PAGENAME}} in pediatric patients.
{{reflist|2}}
http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/050671s014lbl.pdf
[[Category:Antibiotics]]
[[Category:Wikinfect]]


== See also ==
<!--Off-Label Use and Dosage (Pediatric)-->
* [[Drug resistance]]
* [[Antibiotic resistance]]
* [[Methicillin-resistant Staphylococcus aureus]]
* [[Vancomycin-resistant Staphylococcus aureus]]
* [[Vancomycin-resistant enterococcus]]


==External links==
<!--Guideline-Supported Use (Pediatric)-->
* [http://www.vancomycin.co.uk Vancomycin information site and forum]
|offLabelPedGuideSupport======Condition1=====
{{Antidiarrheals, intestinal anti-inflammatory/anti-infective agents}}
{{Other antibacterials}}


[[Category:Glycopeptide antibiotics]]
* Developed by:  


* Class of Recommendation:


[[ar:فانكومايسن]]
* Strength of Evidence:  
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[[pl:Wankomycyna]]
[[pt:Vancomicina]]
[[ru:Ванкомицин]]
[[fi:Vankomysiini]]
[[tr:Vankomisin]]
[[zh:萬古黴素]]
[[sv:Vankomycin]]


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There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
 
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|postmarketing=There is limited information regarding <i>Postmarketing Experience</i> of {{PAGENAME}} in the drug label.
 
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|useInPregnancyAUS=* '''Australian Drug Evaluation Committee (ADEC) Pregnancy Category'''
 
There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of {{PAGENAME}} in women who are pregnant.
|useInLaborDelivery=There is no FDA guidance on use of {{PAGENAME}} during labor and delivery.
|useInNursing=There is no FDA guidance on the use of {{PAGENAME}} with respect to nursing mothers.
|useInPed=There is no FDA guidance on the use of {{PAGENAME}} with respect to pediatric patients.
|useInGeri=There is no FDA guidance on the use of {{PAGENAME}} with respect to geriatric patients.
|useInGender=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific gender populations.
|useInRace=There is no FDA guidance on the use of {{PAGENAME}} with respect to specific racial populations.
|useInRenalImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with renal impairment.
|useInHepaticImpair=There is no FDA guidance on the use of {{PAGENAME}} in patients with hepatic impairment.
|useInReproPotential=There is no FDA guidance on the use of {{PAGENAME}} in women of reproductive potentials and males.
|useInImmunocomp=There is no FDA guidance one the use of {{PAGENAME}} in patients who are immunocompromised.
 
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|overdose====Acute Overdose===
 
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|PK=There is limited information regarding <i>Pharmacokinetics</i> of {{PAGENAME}} in the drug label.
 
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|nonClinToxic=There is limited information regarding <i>Nonclinical Toxicology</i> of {{PAGENAME}} in the drug label.
 
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|alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
 
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|brandNames=* ®<ref>{{Cite web | title =  | url =  }}</ref>
 
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|lookAlike=* A® — B®<ref name="www.ismp.org">{{Cite web  | last =  | first =  | title = http://www.ismp.org | url = http://www.ismp.org | publisher =  | date =  }}</ref>
 
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Revision as of 05:28, 12 December 2014

Vancomycin (oral)
Black Box Warning
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
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Administration & Monitoring
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];

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Black Box Warning

ConditionName:
See full prescribing information for complete Boxed Warning.
ConditionName:
  • Content

Overview

Vancomycin (oral) is a {{{drugClass}}} that is FDA approved for the {{{indicationType}}} of {{{indication}}}. There is a Black Box Warning for this drug as shown here. Common adverse reactions include .

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

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  • Dosing Information
  • Dosage
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  • Dosing Information
  • Dosage
Condition3
  • Dosing Information
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Condition4
  • Dosing Information
  • Dosage

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

Condition1
  • Developed by:
  • Class of Recommendation:
  • Strength of Evidence:
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Guideline-Supported Use of Vancomycin (oral) in adult patients.

Non–Guideline-Supported Use

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Non–Guideline-Supported Use of Vancomycin (oral) in adult patients.

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding FDA-Labeled Use of Vancomycin (oral) in pediatric patients.

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

Condition1
  • Developed by:
  • Class of Recommendation:
  • Strength of Evidence:
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Guideline-Supported Use of Vancomycin (oral) in pediatric patients.

Non–Guideline-Supported Use

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Non–Guideline-Supported Use of Vancomycin (oral) in pediatric patients.

Contraindications

  • Condition1

Warnings

ConditionName:
See full prescribing information for complete Boxed Warning.
ConditionName:
  • Content
  • Description

Precautions

  • Description

Adverse Reactions

Clinical Trials Experience

There is limited information regarding Clinical Trial Experience of Vancomycin (oral) in the drug label.

Body as a Whole
Cardiovascular
Digestive
Endocrine
Hematologic and Lymphatic
Metabolic and Nutritional
Musculoskeletal
Neurologic
Respiratory
Skin and Hypersensitivy Reactions
Special Senses
Urogenital
Miscellaneous

Postmarketing Experience

There is limited information regarding Postmarketing Experience of Vancomycin (oral) in the drug label.

Body as a Whole
Cardiovascular
Digestive
Endocrine
Hematologic and Lymphatic
Metabolic and Nutritional
Musculoskeletal
Neurologic
Respiratory
Skin and Hypersensitivy Reactions
Special Senses
Urogenital
Miscellaneous

Drug Interactions

  • Drug
  • Description

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA):

  • Pregnancy Category


Pregnancy Category (AUS):

  • Australian Drug Evaluation Committee (ADEC) Pregnancy Category

There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Vancomycin (oral) in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Vancomycin (oral) during labor and delivery.

Nursing Mothers

There is no FDA guidance on the use of Vancomycin (oral) with respect to nursing mothers.

Pediatric Use

There is no FDA guidance on the use of Vancomycin (oral) with respect to pediatric patients.

Geriatic Use

There is no FDA guidance on the use of Vancomycin (oral) with respect to geriatric patients.

Gender

There is no FDA guidance on the use of Vancomycin (oral) with respect to specific gender populations.

Race

There is no FDA guidance on the use of Vancomycin (oral) with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Vancomycin (oral) in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Vancomycin (oral) in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Vancomycin (oral) in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Vancomycin (oral) in patients who are immunocompromised.

Administration and Monitoring

Administration

  • Oral
  • Intravenous

Monitoring

There is limited information regarding Monitoring of Vancomycin (oral) in the drug label.

  • Description

IV Compatibility

There is limited information regarding IV Compatibility of Vancomycin (oral) in the drug label.

Overdosage

Acute Overdose

Signs and Symptoms

  • Description

Management

  • Description

Chronic Overdose

There is limited information regarding Chronic Overdose of Vancomycin (oral) in the drug label.

Pharmacology

There is limited information regarding Vancomycin (oral) Pharmacology in the drug label.

Mechanism of Action

Structure

File:Vancomycin (oral)01.png
This image is provided by the National Library of Medicine.

Pharmacodynamics

There is limited information regarding Pharmacodynamics of Vancomycin (oral) in the drug label.

Pharmacokinetics

There is limited information regarding Pharmacokinetics of Vancomycin (oral) in the drug label.

Nonclinical Toxicology

There is limited information regarding Nonclinical Toxicology of Vancomycin (oral) in the drug label.

Clinical Studies

There is limited information regarding Clinical Studies of Vancomycin (oral) in the drug label.

How Supplied

Storage

There is limited information regarding Vancomycin (oral) Storage in the drug label.

Images

Drug Images

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Package and Label Display Panel

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Patient Counseling Information

There is limited information regarding Patient Counseling Information of Vancomycin (oral) in the drug label.

Precautions with Alcohol

  • Alcohol-Vancomycin (oral) interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

Look-Alike Drug Names

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

  1. ↑ Empty citation (help)
  2. ↑ "http://www.ismp.org". External link in |title= (help)

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{{#subobject: 

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