2. Now you
follow…
• Introduction
• Mechanism of action
• Pharmacokinetics
• Indications
• Recommended dosing schedule
• contraindications
• Possible side effects
• Acquired resistance
3. Introduction • Vancomycin is an antibiotic used to treat a no. of
bacterial infections
• Vancomycin was first discovered in 1950 and was
approved by the Federal Drug and Agency (FDA) in
1958
• It is extracted from soil bacteria S. orientalis
• It is a glycopeptide antibiotic used to treat infections
caused by gram-positive bacteria
• Named vancomycin because it was going to vanquish
penicillinase producing S. aureus
4. Mechanism
of action
• Vancomycin acts by inhibiting proper cell wall
synthesis in Gram-positive bacteria
• InhibitCell wall synthesis by binding with ala-D-ala
• Inhibit trans glycosylase.
• Alter cell membrane permeability
• Cell become susceptible to lysis
5. Pharmacokinetics ABSORPTION:
– Vancomycin is poorly absorbed orally in GIT
– When given parenterally drug distributes widely into tissues
– Cmax 63mcg/ml.
– Tmax is 1h
DISTRIBUTION:
– 55% protein bound.
– Vd is 0.3 to 0.43 L/kg
– Distributes well into pleural ,pericardial synovial fluid.
ELIMINATION
– Intravenous: about 75% is excreted in urine by GFR (in 24
hours) as a unchanged.
– Mean half life is 4-6hours
– Oral: faeces
6. Indications
• Treatment of serious infections caused by susceptible
organisms resistant to penicillin's MRSA (methicillin-
resistant S. aureus)and MRSE (multidrug-resistant
Staphylococcus epidermidis)
• For treatment of infections caused by Gram-positive
microorganisms in patients with serious allergies to beta-
lactam antimicrobials
• Antibacterial prophylaxis for endocarditis following
certain procedures in penicillin-hypersensitive individuals
at high risk
• Vancomycin is considered a last resort medication for the
treatment of septicemia and lower respiratory tract, skin,
and bone infections caused by Gram-positive bacteria
• Vancomycin has been the gold standard for treating
hospital acquired infections such as: ventilator associated
pneumonia, Bacteremia (septicemia), Catheter associated
urinary tract infection, Central line associated blood
stream infections, Surgical site infections (SSI)
7. Recommended
dosing
schedule
• ≥ 1 month – 6 years: 40mg/kg/day divided every 6
hours
• > 6 years – 18 years: 40mg/kg/day divided every 8
hours
• > 18 years: 15mg/kg/dose every 12 hours
• Uncomplicated Infections: 10-15 mg/kg q12h1
• Serious Infections:Consider loading dose of 25mg/kg
iv, followed by 15-20 mg/kg 8-12h (45-60mg/kg/day
divided 12h or 8h)
8. Contraindications • Hypersensitive to drug.
• Caution if renal impairment
• Caution if concurrent nephrotoxic agent use
• Caution if hearing impairment
• Caution if concurrent ototoxic agent use
• Caution in elderly pts
• PregnancyCategory C for parenteral route
• May use while breastfeeding;
Patients with Renal disease, inflammatory bowel
disorders may have an increased chance of adverse
effects
9. Possible
side effects
• Fever
• Chills
• Flushing
• Phlebitis
• Ototoxicity**
• Nephrotoxicity**
• Rapid iv infusion may cause diffuse flushing (red man
syndrome)**
• Anaphylaxis/anaphylactoid reaction (Allergy)
10. Acquired
resistance
• The alteration to the terminal amino acid residues of the
NAM/NAG-peptide subunits, under normal conditions, D-
ala-D-ala, to which vancomycin binds.This loss of just one
point of interaction results in a 1000-fold decrease in
affinity
• Three main resistance variants have been characterised to
date among resistant Enterococcus faecium and E.
faecalis populations:
VanA - enterococcal resistance to vancomycin
and teicoplanin; inducible on exposure to these
agents
VanB - lower-level enterococcal resistance; inducible
by vancomycin, but strains may remain susceptible to
teicoplanin
VanC - least clinically important; enterococci resistant
only to vancomycin; constitutive resistance
11. Bullet points • Helpful in MRSA (methicillin-resistant S. aureus)and
MRSE (multidrug-resistant Staphylococcus epidermidis)
• A last resort medication for the treatment of
septicemia and lower respiratory tract, skin, and bone
infections caused by Gram-positive bacteria
• Gold standard for hospital acquired diseases.
