Vancomycin use: narrow spectrum drug
- Staphylococcus aureus including MRSA
- Streptococcus pneumoniae (지역사회 폐렴균으로 유명한), streptococcus spp., Enterococcus spp, C.Jeikeium
- Clostridium species (orally only!)
Indications
- C.diff - if metronidazole ineffective
- MRSA if can't use other
- central line infectino or peritoneal dialysis infection (most likely staph)
Adverse effects (vancomycin S/E)
- Dose-related Ototoxicity
- Dose-related Nephrotoxicity
- Anaphylaxis
- Histamine release: rapid injection → redman syndrome
- Redman syndrome; related to rapid infusion
- Erythema, vasodilation, hypotension, and chills - Thrombophlebitis (vessel irritation)
Vancomycin Guidlines
Administration
- typically, 15mg/kg q 12 hours
- IV dosing over 60min
- IV use (PO or rectal use only for C.diff)
- Vancomycin resistent enterococci (VRE) 주의
- Trough level (10~20mcg/ml): 30min before next dose to maintain maximum effect concentration
- Peak level (30~40mcg/ml) measure 1.5-2.5 hours after IV completed - 보통 쓰이진 않음
Trough observation
- Requiring therapy more than 4 days
- Severe or life threatening infections
- Receiving concomitant nephrotoxic drugs (ie. NSAIDS, antibiotics, chemotheray medication)
- Morbidly obese (지방의 인지질이 vancomycin을 잡아두었다가 release하는 성격, 혈중농도에 영향을 준다)
- Guidlines recommend only trough, Peak nor necessary