Vancomycin

Dose:

Neonate:
- Postnatal age <7 days, 15-30 mg/kg/day IV divided at 24-12 hour intervals
- postnatal age >7 days, 15-45 mg/kg/day IV divided at 8 hour intervals
Children:
- 45-60 mg/kg/day IV divided at 8-12 hour intervals
- Oral dosing for antibiotic-associated enterocolitis 40-50 mg/kg/day PO divided at 6-8 hour intervals

For the selected dose, the options are:

Note:

Intravenous 500 mg injection:
- 1 vial (500 mg) is to be reconstituted with 10 ml of water for injection. The resultant solution will be further diluted with 100ml solution of 0.9% sodium chloride or 5% glucose. Then final solution will be infused for atleast 1 hour.
Intravenous 1gm injection:
- 1 vial (1gm) is to be reconstituted with 20 ml of water for injection. The resultant solution will be further diluted with 200ml solution of 0.9% sodium chloride or 5% glucose. Then final solution will be infused for atleast 2 hours.

Drug Pharmacology

Drug Class

Glycopeptide antibiotics

Description

Vancomycin is a branched tricyclic glycosylated nonribosomal peptide produced by the fermentation of the Actinobacteria species Amycolatopsis orientalis (formerly Nocardia orientalis). It is often reserved as the "drug of last resort", used only after treatment with other antibiotics has failed.

Structured Indications

Clostridium Difficile-Associated Diarrhea (CDAD)
Enterocolitis caused by Staphylococcus aureus
Infection caused by staphylococci
Severe Staphylococcal infection

Mechanism of Action

The bactericidal action of vancomycin results primarily from inhibition of cell-wall biosynthesis. Specifically, vancomycin prevents incorporation of N-acetylmuramic acid (NAM)- and N-acetylglucosamine (NAG)-peptide subunits from being incorporated into the peptidoglycan matrix; which forms the major structural component of Gram-positive cell walls. 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. In addition, vancomycin alters bacterial-cell-membrane permeability and RNA synthesis. There is no cross-resistance between vancomycin and other antibiotics. Vancomycin is not active in vitro against gram-negative bacilli, mycobacteria, or fungi.