Vancomycin

Question 1

Vancomycin - indications

Answer 1

1) Treatment of Gram(+) infection:
- endocarditis
- where infection is severe +/- penicillins cannot be used due to resistance or allergy.

2) Treatment of antibiotic-associated colitis caused by Clostridium difficile infection (usually second-line treatment where metronidazole is ineffective or poorly tolerated).

Question 2

Vancomycin - MOA

Answer 2

1) inhibits growth and cross-linking of peptidoglycan chains

2) inhibiting synthesis of the cell wall of Gram(+) bacteria = cell lysis + bacterial cell death (bactericidal).

Question 3

Vancomycin - Adverse effects

Answer 3

Most common:
1) pain and inflammation of the vein (thrombophlebitis) at the infusion site.

IV vancomycin:

2) nephrotoxicity -including renal failure and interstitial nephritis
3) ototoxicity - with tinnitus and hearing loss
4) neutropenia and thrombocytopenia.

Question 4

Vancomycin - interactions

Answer 4

aminoglycosides

loop diuretics

ciclosporin

Question 5

Vancomycin - dose reduction and caution in patients with..

Answer 5

1) renal impairment

2) elderly