Class of antibiotic: 

 It is a Glycopeptide antibiotic

Mechanism of action :

Inhibition of bacterial cell wall synthesis by binding D-ala-D-ala

Spectrum of action: 

This is active against Gram (+) bacteria Including: Listeria, Rhodococcus, Peptostreptococcus

Bacteriostatic against enterococcus

Routes of administration

Can be used intravenously or orally

Drug of Choice in the following conditions

MRSA

Indications

IV:  Serious methicillin-resistant Staphylococcal infections: pneumonia, endocarditis, osteomyelitis, SSSI

Oral route:  It is used for pseudomembranous colitis (metronidazole preferred)

Staphylococcal infections in Penicillin allergic patients

Vancomycin should  not  be used in non-Penicillin allergic patients.  Vancomycin does not kill as rapidly as antistaphylococcal β-lactams, and may negatively impact clinical outcome

Unique Qualities of vancomycin

• Monitor trough serum concentrations
• Poor oral absorption
• Adjust dose for renal impairment

Adverse drug reaction of Vancomycin

• “Red Man” Syndrome
• Ototoxicity
• Nephrotoxicity with other nephrotoxic agents

Mechanism of resistance:

Enterococcus:  Van A – E

Peptidoglycan precursor has decreased affinity for vancomycin – D-ala-D-ala replaced by D-ala-D-lac

Staphylococcus aureus:

VISA isolates:

Increased amount of precursor with decreased affinity

Thicker cell wall

hVISA:  heterogenous bacterial population

Dose of vancomycin:

Based on total body weight and renal function

15 – 20 mg/kg

Normal renal function:  q 12 dosing

Goal trough concentrations:

10 – 15 mcg/mL:  bacteremia, skin and soft tissue infections

15 – 20 mcg/mL:  osteomyelitis, meningitis, pneumonia