Antibiotics: Vancomycin

Question 1

Indications of vancomycin?

Answer 1

Gram-positive infection e.g. endocarditis

Antibiotic-associated collitis (e.g. C.diff)

Question 2

Spectrum activity of vancomycin?

Answer 2

Narrow spectrum

Works against Gram-positive bacteria (MRSA, Strep Spp, C.diff, VRE)

Question 3

MOA of vancomycin?

Answer 3

Inhibit the growth and cross-linking peptidoglycan chains.
→ This inhibits synthesis of the cell wall in Gram-positive bacteria.
→ This causes lysing and killing of the bacteria -BACTERICIDAL.

Question 4

Adverse effects of vancomycin?

Answer 4

Thrombophlebitis (pain + inflammation of the vein at infusion site)

Red man syndrome (erythema, may be associated with hypotension and bronchospasm).

Immediate or delayed hypersensitivity.

IV vancomycin can cause:
- nephrotoxicity
- ototoxicity
- neutropenia
- thrombocytopenia

Question 5

Warnings of vancomycin?

Answer 5

Dose reduction for:​
- Pts with renal impairment ​
- Elderly (risk of hearing impairment)

Question 6

Interactions of vancomycin?

Answer 6

Increases risk of ototoxicity and nephrotoxicity when prescribed with:​
- Aminoglycosides​
- Loop diuretics​
- Ciclosporin (immunosuppressant drug)

Question 7

Monitoring of vancomycin?

Answer 7

If IV administration:
- measure PLASMA VANCOMYCIN conc before and during TX.

Efficacy assessed by:
- improvement in signs/symptoms
- inflammatory markers (CRP and WCC)

Safety assessed:
- renal function
- platelet and leucocyte counts (in prolonged course)

Question 8

Pt education of vancomycin?

Answer 8

Aims to get rid of infection and improve symptoms.

Report any ringing in the ears or change in hearing during tx.
→ this is ONLY reversible if tx stopped promptly.