Vancomycin
Class
Glycopeptide
Dose
25-30mg/kg (load)
+
1.5mg bd-tds (normal renal fn)
Mechanism
Cell Wall Inhibitor
MoA
Binds D-Ala-D-Ala sequence on bacterial cell wall
Interrupts peptidoglycan synthesis → Bactericidal
Time v Concentration
Time > MIC
Post dose effect
Short
Spectrum
Covers
Doesn't Cover
G+ including MRSA
C diff (oral only)
C perfringens
G -ves
VRE/VRSA
Anaerobes
Indications
Suspected/proven MRSA
C diff
Penicillin allergy
PK
A
Poor. Only po for C diff
D
PPB 50%. Vd 2L/kg
M
None
E
Renally excreted unchaged. ∴needs dose adjustment in renal failure
Critical Illness
A/E
Red man syndrome; mass histamine release (related to rate of infusion not an allergy. Cease and recommence at a slower rate)
Ototoxicity: related to peak dose
Drug fever
Resistance
Bacteria mutate to D-Ala-D-lactate
∴ no binding site for Vanc
Monitoring
Renal Function
Levels required; as per hospital protocol eg trough target 15-20mg/dL