Chibuzo Anyama- A Review of vancomycin use in the Medical/Surgical floor

1. A Review of vancomycin use
in the Medical/Surgical floor
Chibuzo Anyama
Lamar University
MSNE 5356
Advanced Pharmacology

2. Drug Chosen: vancomycin
• Common prescriptions in the medical/surgical
floor: lisinopril (Zestril), promethazine
(Phenergan), vancomycin (Vancocin), aspirin
(Ecotrin), propranolol (Inderal), hydromorphone
(Dilaudid), furosemide (Lasix), etc.
• Drug Chosen: vancomycin (Vancocin)

3. Pathophysiological Condition
Treated
• Condition: community acquired methicillin
resistant staphylococcus aureus (CA-MRSA) skin
infection (cellulitis).
• Transmission- Skin contact
• Facilitating conditions- Immunocompromised
(antineoplastic, steroid medications, cuts,
laceration, puncture wounds, etc.)
• Crowded living conditions

4. Intended Drug Response
• Vancomycin- A tricyclic glycopeptide antibiotic
• Binds with high affinity to D-alanine (D-ala) and D-
lactate (D-ala) C-terminals of MRSA bacteria,
compromising the cell wall integrity (Bruniera, 2015).
• Higher osmotic pressure within bacterial cell cytoplasm
pulls water from external cell environment into cell.
• Osmotic burst (bacteriolysis) of the bacterial cell results
in cell death –i.e. vancomycin is bactericidal (Medinaz,
2017).

5. Potential Interactions
• Vancomycin when co-administered with cisplatin
(antineoplastic agent), aminoglycosides (gentamicin,
kanamycin, and neomycin), cyclosporine, aspirin, and
loop diuretics like furosemide, would cause additive
nephrotoxicity and ototoxicity.
• Vancomycin potentiates effect of non-depolarizing
neuromuscular blocking agents (NMBAs)-pancuronium ,
atracurium , and vecuronium.
• Piperacillin-tazobactam (Zozyn) coadministration with
vancomycin- increases risk of acute kidney injury (AKI)
(Bamgbola, 2016).

6. Adverse Drug Reactions
• Hypersensitivity reaction -urticaria,
exfoliative dermatitis, macular rashes, etc.
• Events related to infusion –phlebitis,
erythema, flushing, hypotension,
tachycardia, red man syndrome.
• Ototoxicity
• Nephrotoxicity

7. Side Effects of Vancomycin
•Nausea and vomiting
•Back and neck pain
•Chills and fever
•Vertigo, dizziness, and tinnitus (may
be symptom before the onset of
ototoxicity).

8. Pharmacokinetics of
Vancomycin
• Absorption -Poorly administered in gastrointestinal (GI)
tract when administered by mouth (PO).
• Distribution -lipophilic drug, large volume distribution,
widely distributed, crosses placenta, and 20-30% enters
CSF (Davis, 2017).
• Metabolism -Poorly metabolized (5%) (Bruniera et al.,
2015).
• Excretion -IV 90% renal excretion. PO excreted in feces
(Bruniera et al., 2015).
• Half-life: 4-11 hours in adults but longer in adults with
renal failure i. e. 7 days (Bruniera et al., 2015)

9. Drug Binding Issues
• No drug is known to affect the binding of
vancomycin (VCM) at the D-ala and D-ala
C-terminals of the peptidoglycan cell walls
of staphylococcus bacteria cell.
• Hypoalbuminemia only elongates
vancomycin half-life (Mizuno et al., 2013).
• Ototoxic and nephrotoxic drugs has
additive effects on vancomycin but does
not affect the binding of vancomycin.

10. Improving Interprofessional team
member communication.
• Teach back or repeat back method to be applied
not only to patients but also among members of
the interprofessional team.
• Physicians to take more time to listen to patients
without early interrruption.
• Adequate staffing to encourage structured
interdisciplinary rounding.
• The need for physicians and other prescribers to
communicate more with each other.

11. Application to the practice
setting
• Closely monitor kidney function while administering
vancomycin especially on renal patients.
• Piperacillin-tazobactam, cisplatin, aminoglycosides,
cyclosporine, aspirin, and loop diuretics like furosemide,
etc., need to be avoided during vancomycin therapy.
• Effective interdisciplinary team communication
necessary for improved outcomes including VCM therapy
outcomes.
• Effective listening, teach back method, structured
interdisciplinary rounding need to be applied.

12. References
• Bamgbola, O. (2016). Review of vancomycin-induced renal toxicity: an update.
Therapeutic Advances in Endocrinology and Metabolism, 7(3), 136–147.
http://doi.org/10.1177/2042018816638223
• Bruniera, F. R., Ferreira, F. M., Saviolli, L. R. M., Bacci, M. R., Feder, D., Pedreira,
M. G., . . . Fonseca, F. L. (2015). The use of vancomycin with its therapeutic
and adverse effects: a review. European Review for Medical and
Pharmacological Sciences, 19(4), 694-700.
• Davis, F. A. (2017). Davis’s drug guide for nurses (15th ed.). Philadelphia, PA: F. A.
Davis
• Medinaz, [Medinaz]. (2017, September 3). Vancomycin Mechanism of action.
Retrieved from https://www.youtube.com/watch?v=gf-Za1kYfdo
• Mizuno, T., Mizokami, F., Fukami, K., Ito, K., Shibasaki, M., Nagamatsu, T., &
Furuta, K. (2013). The influence of severe hypoalbuminemia on the half-life
of vancomycin in elderly patients with methicillin-resistant Staphylococcus
aureus hospital-acquired pneumonia. Clinical Interventions in Aging, 8,
1323–1328. http://doi.org/10.2147/CIA.S52259