Vancomycin oral
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Oral formulations of vancomycin as vancomycin hydrochloride
Drugs List
Therapeutic Indications
Uses
Pseudomembranous colitis due to Clostridium difficile
Dosage
Adults
125mg every 6 hours for 10 days. May be increased to 500mg every 6 hours for 10 days in severe cases. Maximum dose 2g per day.
Children
Children aged 12 to 18 years
125mg every 6 hours for 10 days. May be increased to 500mg every 6 hours for 10 days in severe cases. Maximum dose 2g per day.
Children aged from 1 month to 12 years
10mg per kg every 6 hours for 10 days. Maximum dose 2g per day.
Neonates
10mg per kg every 6 hours for 10 days. Maximum dose 2g per day.
Additional Dosage Information
An oral solution may be prepared by dissolving 500 mg of vancomycin hydrochloride powder for solution for infusion in water and given to the patient to drink or administered by nasogastric tube. Any commonly used flavouring syrup may be added at the time of administration to improve the taste.
Vancomycin is not significantly absorbed from the normal gastrointestinal tract and is therefore not effective by the oral route for other types of infection. Intravenous administration may be used concomitantly if required.
Contraindications
None known
Precautions and Warnings
Auditory impairment
Breastfeeding
Inflammatory bowel disease
Pregnancy
Renal impairment
Consult national/regional policy on the use of anti-infectives
Monitor auditory function, esp if hearing loss or other ototoxic agents
Monitor drug levels in patients with C.difficile taking multiple oral doses
Monitor for signs of superinfection with non-susceptible organisms
Monitor renal function regularly
Some patients with inflammatory disorders of the intestinal mucosa may have significant systemic absorption of vancomycin and, therefore, may be at risk for the development of adverse reactions associated with the parental administration of vancomycin. The risk if greater in patients with renal impairment. Note that total systemic and renal clearances of vancomycin are reduced in the elderly.
When treating patients with underlying renal impairment or patients receiving concurrent therapy with an aminoglycoside, perform serial monitoring of renal function.
All patients should have periodic haematological studies, urine analysis, hepatic function and renal function tests. Measure plasma vancomycin concentrations after 3 to 4 doses or earlier if there is evidence of renal impairment.
Pregnancy and Lactation
Pregnancy
Use vancomycin with caution during pregnancy.
The manufacturer advises caution if vancomycin is used during pregnancy. Available reports indicate no increased risk of teratogenic effects or evidence of foetal harm.
The potential ototoxic and nephrotoxic effects of vancomycin were evaluated on infants in a controlled study when the drug was administrated to pregnant women for serious staphylococcal infections complicating intravenous drug abuse. No sensorineural hearing loss or nephrotoxicity was attributable to vancomycin, however vancomycin hydrochloride was found in the cord blood. Vancomycin was only administrated in the second or third trimesters, therefore it is unknown whether it causes foetal harm when administrated earlier in pregnancy.
Lactation
Use vancomycin with caution during breastfeeding.
The manufacturer advises caution if vancomycin is used when breastfeeding.
Available data indicates vancomycin is expressed into human milk but it is unlikely that the infant can absorb a significant amount therefore it is not expected to cause any adverse effects. The infant may be affected by the modification of bowel flora, allergic response or sensitisation effects and the interference with the interpretation of culture results, if a fever work up is required.
Side Effects
"Red man" syndrome (flushing of upper body)
Agranulocytosis
Anaphylaxis
Blood urea increased
Cardiac arrest
Chills
Diarrhoea
Dizziness
Drug fever
Dyspnoea
Eosinophilia
Exfoliative dermatitis
Hearing loss
Hypersensitivity reactions
Hypotension
Interstitial nephritis
Linear IgA bullous dermatosis
Lyell's syndrome
Mucosal inflammation
Muscle spasm and pain of back and chest
Nausea
Neutropenia
Pain
Pancytopenia
Phlebitis
Pruritus
Rash
Renal failure
Serum creatinine increased
Stevens-Johnson syndrome
Thrombocytopenia
Tinnitus
Urticaria
Vasculitis
Vertigo
Vomiting
Wheezing
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: October 2016
Reference Sources
Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.
Summary of Product Characteristics: Vancocin Matrigel Capsules 125mg. Flynn Pharma Ltd. Revised March 2018.
The Renal Drug Handbook. Fourth Edition (2014) ed. Ashley, C and Dunleavy, A, Radcliffe Publishing Ltd, London.
US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://www.ncbi.nlm.nih.gov/books/NBK501922/
Vancomycin Last revised: 31 October 2018
Last accessed: 02 April 2020
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 24 November 2022.
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