I am professionally pharmacist. These slides for clinical subject especially for pharmacy department students. I hope students get more benefits about it.
2. Mechanism of Action of Vancomycin
Vancomycin binds to the D-alanyl-D-alanine dipeptide on the peptide side chain
of newly synthesized peptidoglycan subunits, preventing them from being
incorporated into the cell wall by penicillin-binding proteins (PBPs). In many
vancomycin-resistant strains of enterococci, the D-alanyl-D-alanine dipeptide is
replaced with D-alanyl-D-lactate, which is not recognized by vancomycin. Thus, the
peptidoglycan subunit is appropriately incorporated into the cell wall.
3. Vancomycin Resistance
• Some Enterococci have developed resistance to
vancomycin (Enterococcus faecium and
Enterococcus faecalis).
• These bacteria are called Vancomycin Resistant
Enterococci (VRE)
4. Gram-positive
bacteria
Staphylococcus aureus,
Staphylococcus epidermidis,
Streptococcus pyogenes. Viridans
group streptococci, Streptococcus
pneumoniae, Some enterococci.
Gram-negative
bacteria
since the large size of the
vancomycin molecule prohibits
its passing of the outer
membrane.
Anaerobic bacteria Clostridium spp. Other Gram-
positive anaerobes.
Atypical bacteria
Antimicrobial Activity of Vancomycin
5. Calculating the Trough Level
Half-life is mostly affected in obese, geriatrics and imputed patients
6. Kel = elimination constant
• In addition among obese, elderly and
amputed patients Q8H intervals leading to
a lower Kel, and subsequently prolonged
t½.
• Lower Kel in obesity may lead to dose
“stacking”
7. • vancomycin is primarily renally eliminated,
the elimination constant (Kel) is directly
related to creatinine clearance (CrCl).
8. New therapeutic daily dose
• 1000mg IV Q12H results in a trough of 10.
To target a trough of 15, you would target
a 50% increase in TDD
9. Protocol design for Vancomycin
• Protocol for Abs is vital step in the
antibiotic stewardship programs
10. Key steps in AMS
• Implement policies that support optimal
antibiotic use.
• Document dose, duration
• Develop and implement facility specific
treatment recommendations.
11. Key steps in AMS
• Monitor Abs use
• Monitor prescribing pattern
• Monitor outcomes
• Educate and Improve
12. Contents of protocol for VANC
1- Inclusion/ exclusion criteria based on the ward
setting
2- VANC is under restricted for use Abs and need
ID consultant permission to use based
1- suspected infections
2- Severity of symptoms
3- On MCS report
13. 3- Vancomycin Administration
• Vancomycin is very irritating to tissue, and
should not be given intramuscularly as this
causes injection site necrosis.
• Vancomycin should not be given rapidly
due to the risk of infusion reactions.
14. 3- Vancomycin Administration
• The intravenous use of vancomycin may
be associated with the so-called 'red-neck'
or 'red-man' syndrome, characterised by
erythema, flushing, or rash over the face
and upper torso, and sometimes by
hypotension and shock-like symptoms.
15. 3-Vancomycin Administration
• In order to avoid these risks:
• Vancomycin must ALWAYS be
administered by intravenous INFUSION in
either 0.9% Sodium Chloride or 5% Glucose
• Final concentration: NOT MORE THAN
5mg/mL for peripheral administration
• Rate of infusion: NO FASTER THAN
10mg/min
17. 5-Dose calculation
• Give loading dose based on the actual
body wt
• Estimate Crcl, if SerCrt is not avialbale
then the protocol must have a dosing chart
based on the actual body wt of the
patients
19. 6-Monitor the vancomycin
concentration and reassess the dose
• Target trough vancomycin concentrations 10 – 20mg/L
• If the patient is seriously ill (severe or deep-seated
infection), the target trough concentration range is 15 -
20mg/L. If the measured concentration is
21. 7- Imp Documentation
• Record the exact times of all measured concentrations
on the Vancomycin Intravenous Infusion Prescription
and Administration record.
• Undertake pre-prescribing checks to assess the risk of
toxicity.
• Reassess the dose and continue or prescribe a dosage
change.
22. 7- Imp Documentation
• Document the action taken in the medical notes and on
the Vancomycin Intravenous Infusion Prescription and
Administration record.
• Review the need for vancomycin daily.
23. 8- Daily monitoring
• Renal profile
• Urine out put, <200ml is an indicate of
renal toxicity
