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Vancomycin parenteral

Updated 2 Feb 2023 | Glycopeptide antibiotics


Powder for solution for infusion or oral solution of vancomycin hydrochloride

Drugs List

  • vancomycin 1g powder for solution for infusion vial
  • vancomycin 500mg powder for solution for infusion vial
  • Therapeutic Indications


    Bacterial endocarditis
    Endocarditis - prophylaxis
    Infections due to Gram-positive organisms incl. penicillin-resistant staph.
    Pseudomembranous colitis due to Clostridium difficile

    Unlicensed Uses

    Cerebral ventriculitis
    Peritonitis associated with dialysis


    Pre-dose serum concentrations must be determined daily and the dose adjusted accordingly.

    Once vancomycin powder has been reconstituted it requires further dilution before administration. Concentrations of no more than 5 mg/ml are recommended with the exception of fluid-restricted patients where concentrations up to 10 mg/ml may be used. Infusion rates of more than 10 mg/minute increase the risk of infusion related adverse events. Infusion related adverse events are related to both concentration and rate of administration.

    Duration of therapy is determined by type and severity of infection and clinical response.

    Vancomycin is not to be given orally for systemic infections due to poor absorption.


    Infections due to Gram-positive bacteria
    Loading dose in seriously ill patients: 25 to 30mg per kg. Maximum dose 2g.
    Maintenance dose: 15 to 20mg per kg every 8 to 12 hours. Maximum dose 2g per day.
    Target trough concentrations: 10 to 20mg per litre, dependant on site of infection and susceptibility of the pathogen.

    Prophylaxis of endocarditis
    Standard dose: 15mg per kg, once only. An additional dose may be given depending upon duration of surgery.
    Other sources suggest for high risk of MRSA 1g may be given as a single dose.


    Infections due to Gram-positive bacteria
    Children aged 12 to 18 years
    Loading dose in seriously ill patients: 25 to 30mg per kg. Maximum dose 2g.
    Maintenance dose: 15 to 20mg per kg every 8 to 12 hours. Maximum dose 2g per day.
    Children aged 1 month to 12 years
    10 to 15mg per kg every 6 hours.

    Prophylaxis of endocarditis
    Children aged from 1 month to 18 years
    15mg per kg, once only.

    Cerebral ventriculitis (unlicensed)
    Children aged 1 month to 18 years
    5 to 20mg every 24 hours.


    Prophylaxis of endocarditis
    15mg per kg, once only.

    Cerebral ventriculitis (unlicensed)
    10mg every 24 hours.

    Patients with Renal Impairment

    Dosage adjustment must be made to avoid toxic levels.

    Creatinine clearance between 20 to 49ml/min - Starting dose 15 to 20mg/kg every 24 hours.
    Creatinine clearance below 20ml/ml (or those on renal replacement therapy) - Timing and amount of subsequent doses depend on the modality of renal replacement therapy and should be based on serum vancomycin trough levels and on residual renal function.
    Critically ill patient with renal insufficiency - Loading dose 25 to 30mg/kg should not be reduced.

    Children 1 year and over
    GFR 30 to 50ml/min - 15mg/kg every 12 hours.
    GFR 10 to 30ml/min - 15mg/kg every 24 hours.
    GFR less than 10ml/min - 10 to 15mg/kg. Timing and subsequent doses depend on the modality of renal replacement therapy.
    Intermittent haemodialysis and peritoneal dialysis - 10 to 15mg/kg. Timing and subsequent doses depend on the modality of renal replacement therapy.
    Continuous renal replacement therapy - 15mg/kg. Timing and subsequent doses depend on the modality of renal replacement therapy.

    Alternatively, from the Renal Drug Handbook:
    GFR 20 to 50ml/minute - Intravenous vancomycin dose 500mg to 1g every 12 to 24 hours
    GFR 10 to 20ml/minute - Intravenous vancomycin dose 500mg to 1g every 24 to 48 hours
    GFR less than 10ml/minute - Intravenous vancomycin dose 500mg to 1g every 48 to 96 hours
    The oral dose should be equivalent to patients with normal renal function.


    Intravenous administration
    Vancomycin should be administered as a slow intravenous infusion of at least one hour duration or at a maximum rate of 10mg/min whichever is longer.
    Continuous vancomycin infusion may be considered, for example, in patients with unstable vancomycin clearance.

    Oral administration
    The contents of the vials for parenteral administration may be used.
    Each dose may be reconstituted in 30ml water and either given to the patient to drink, or administrated by nasogastic tube. Common flavouring syrups may be added to the solution at the time of administration to improve the taste.


    Auditory impairment

    Precautions and Warnings

    Inflammatory bowel disease - if administered orally/enterally
    Renal impairment

    Potentially ototoxic and nephrotoxic-use with care in renal insufficiency
    Reduce dose in patients with renal impairment
    Consult national/regional policy on the use of anti-infectives
    Not all available brands are licensed for all indications
    Not all available brands are licensed for all routes of administration
    Avoid rapid infusion rates
    Infuse over at least 60 minutes
    Vary infusion site
    Monitor auditory function in at risk patients before and during treatment
    Consider pseudomembranous colitis if patient presents with severe diarrhoea
    During treatment perform blood counts, BUN/creatinine and urine analysis
    History of hearing loss - monitor drug levels
    Monitor drug levels in patients with C.difficile taking multiple oral doses
    Monitor haematological parameters periodically
    Monitor hepatic function regularly
    Monitor peak and trough serum levels
    Monitor periodically for overgrowth of non-susceptible organisms
    Monitor renal function regularly
    Discontinue if hypersensitivity reactions occur
    Discontinue if tinnitus occurs
    Discontinue permanently if severe skin reaction occurs

    Significant systemic absorption of oral vancomycin may occur in patients with inflammatory disorders of the intestinal mucosa, therefore these patients may be at risk of developing adverse reactions associated with the parenteral administration of vancomycin. The risk is greater in patients with renal impairment.

    Although very little vancomycin is absorbed from the gastrointestinal tract following oral administration, clinically significant serum concentrations have been reported in some patients who have taken multiple oral doses of vancomycin for active Clostridium difficile -induced pseudomembranous colitis. Monitoring of serum concentrations may be appropriate in these patients.

    Total systemic and renal clearance of vancomycin are reduced in the elderly.

    Concurrent anaesthesia may enhance some adverse effects of vancomycin. Vancomycin infusions should be completed before induction of anaesthesia.
    Anaesthetic induced myocardial depression may be enhanced by vancomycin. Doses should be well reduced and close cardiac monitoring is recommended. Position changes should be delayed until infusion is complete to allow for postural hypotension.

    Pregnancy and Lactation


    Use vancomycin with caution during pregnancy.

    The manufacturer recommends that vancomycin should be given in pregnancy only if clearly needed and blood levels should be monitored carefully to minimise the risk of foetal toxicity. There is very limited data on the use of vancomycin in human pregnancy. It has been reported that pregnant patients may require significantly increased doses of vancomycin to achieve therapeutic serum concentrations. Teratology studies have been performed at 5 times human dose in rats and 3 times human dose in rabbits and have shown no evidence of foetal harm. In a controlled clinical study, the potential ototoxic and nephrotoxic effects of vancomycin hydrochloride on infants were evaluated when it was administered to pregnant women for serious staphylococcal infections complicating intravenous drug abuse. Vancomycin was found in cord blood but no sensorineural hearing loss or nephrotoxicity attributable to vancomycin was noted (one infant had conduction hearing loss reported). Vancomycin was administered only in the second or third trimesters, therefore it is unknown if it causes foetal harm when administered earlier in pregnancy.


    Use vancomycin with caution during breastfeeding.

    The manufacturer advises caution should be exercised when vancomycin is administered to a nursing mother. Vancomycin is excreted in human milk. It is unlikely that an infant can absorb a significant amount of vancomycin from its gastro-intestinal tract and it is not expected to cause any adverse effects.

    Side Effects

    "Red man" syndrome (flushing of upper body)
    Acute generalised exanthematous pustulosis
    Anaphylactoid reaction
    Blood urea increased
    Bullous dermatoses
    Bullous eruption
    Cardiac arrest
    Cardiogenic shock
    Drug fever
    Drug rash with eosinophilia and systemic symptoms (DRESS)
    Exfoliative dermatitis
    Hearing loss
    Hypersensitivity reactions
    Infusion-related symptoms
    Interstitial nephritis
    Macular abnormalities
    Muscle spasm and pain of back and chest
    Overgrowth by non-susceptible organisms
    Pseudomembranous colitis
    Renal failure
    Serum creatinine increased
    Stevens-Johnson syndrome
    Toxic epidermal necrolysis


    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 ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: January 2023

    Reference Sources

    Summary of Product Characteristics: Vancomycin 1g Powder for Concentrate for Solution for Infusion and oral solution. Kent Pharma UK Ltd. Revised April 2021.
    Summary of Product Characteristics: Vancomycin 500mg Powder for Concentrate for Solution for Infusion and oral solution. Kent Pharma UK Ltd. Revised April 2021.

    The Renal Drug Handbook. Fifth Edition (2019) ed. Ashley, C. and Dunleavy, A. Radcliffe Publishing Ltd, London.

    NICE Evidence Services Available at: Last accessed: 12 January 2023

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