Vancomycin

Question 1

Therapeutic Range:

Answer 1

Therapeutic Range: Trough 10 to 15mg/L (15 to 20mg/L for endocarditis or less sensitive strains of
methicillin-resistant Staphylococcus aureus or complicated infections caused by S. aureus).
Loading doses may be required.

Question 2

Monitoring

Answer 2

Serum potassium, full blood count, renal function, auditory function in elderly, urinalysis

Question 3

Major Route of Elimination

Answer 3

Renal; 70 to 90% excreted unchanged in urine

Question 4

Warning Signs

Answer 4

• Hearing loss, vertigo, dizziness, tinnitus
• Flushing of the upper body (‘Red Man Syndrome’)
• Blood disorders (signs of infection such as fever, sore throat, mouth ulcers, also unexplained
bruising or bleeding) e.g. neutropenia, thrombocytopenia
• Phlebitis (irritant to tissue)
• Nephrotoxicity e.g. elevated serum creatinine concentrations
• Skin disorders e.g. rashes, toxic epidermal necrolysis, pruritus

Question 5

Other side effects:

Answer 5

Hypotension and anaphylactic reactions can occur if administered too quickly

Question 6

Actions Required

Answer 6

• Advise patient to report immediately to a doctor if any warning signs occur

Question 7

Interactions

Answer 7

• Increased risk of nephrotoxicity and ototoxicity when vancomycin given with ciclosporin,
aminoglycosides, polymixin antifungals
• Increased risk of ototoxicity when vancomycin given with loop diuretics
• Vancomycin enhances effects of suxamethonium