Drug Monograph for Serious Infections Essay

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Vancomycin should be given for at least 60 minutes. The initial dosage for pediatrics with renal impairment is not less than 15 mg/kg per day or 15 times the GFR in mL/min. Premature infants should have longer dosing intervals. PO administration should be 40 mg/kg/day in 3-4 divided doses for 7-10 days. The maximum is 2,000 mg/day, which may be diluted in 1 oz of water or administered through an NG tube (PDR).


Vancomycin is contraindicated to patients with hypersensitivity to vancomycin (Drug.com, 2012). Commercially prepared frozen Vancomycyn Hydrochloride injections in 5% dextrose may also be contraindicated to those with known allergic reaction to corn or corn products (Drug.com).

Drug-Drug Interactions

The patient should inform the doctor or pharmacist of all prescription and non-prescription or herbal products currently used (Medicine Net, 2012; Levinson, 2012). Aminoglycosides, amphotericin B, other antibiotics, and live bacterial vaccines are special mentions. If treatment requires anesthesia, the doctor or dentist should be told if the patient has been using Vancomycin. Although most antibiotics do not significantly affect hormonal birth control medications, they may decrease the effectiveness of these hormone medications and cause pregnancy (Medicine Net).

Current or sequential systemic or topical use of neurotoxic or nephrotoxic drugs should be carefully monitored (PDR, 2012). Periodic leukocyte count monitoring with drugs, which may cause neutropenia, should be performed. Serial monitoring of renal function and particular care after dosing should also be done to minimize the risk of nephrotoxicity with concomitant aminoglycoside (PDR).

Other Precautions and Potential Adverse Effects

A patient's medical history should be revealed before Vancomycin is administed

(Medicine Net, 2012). Elderly patients should be able to eliminate the drug from their bodies when needed. Otherwise, it should be administered to them with caution for possible sensitivity to its effects. It should be used on pregnant women only when clearly needed. Risks and benefits should be discussed with the doctor. Vancomycin does not pass on to breast milk and is thus not harmful to nursing infants. But the doctor must still be consulted on its effect on breastfeeding (Medicine Net).

Vancomycin may cause hypotension and cardiac arrest, though rarely, by rapid bolus administration (PDR, 2012).
Ototoxicity has been reported and calls for caution for those with underlying hearing loss. Prolonged use can lead to an overgrowth of non-susceptible organisms. Safety and efficacy of administration through the intraperitoneal and intrathecal routes have not been confirmed. Use via the intraperitoneal route during dialysis has been reported to lead to a syndrome of chemical peritonitis (PDR).

Look-alike/Sound-alike Drugs and Prescription Refill Requirements

Vancomycin is 6th in the list of top 10 medications involved in drug errors (Medscape Pharmacists, 2007). These medications are the most commonly mis-used or mishandled some way by healthcare professionals, based on the database of the U.S. Pharmacopoeia. Liquid dose concentrations increase the risk of medication errors. There has been confusion over mL and tsp errors, which leads to overdose or under-dose of up to 5 times if undetected. Reconstituting antibiotics can also be risky as when the antibiotic powder is mixed with alcohol instead of distilled water (Medscape Pharmacists).

Vancomycin was also one of the 10 most frequently reported drugs with the highest adverse drug reactions by the Adverse Drug Reaction Reporting Program for 2003-2004 (Bebout, 2004). Half of all the 360 drugs were anti-infective (Bebout). #


Bebout, K. (2004). Adverse drug reporting program update and recent drug safety warnings. P & T. News: the University of Iowa Carver College of Medicine. Retrieved on April 20, 2012 from http://www.healthcare.uiowa.edu/pharmacy/PTNews/2004/december.html

Drug.com (2010). Vancomycin Hydrochlorde. Drugs.com. Retrieved on April 20, 2012

from http://www.drugs.com/monograph/vancomycin-hydrochloride.html

Harrison's Practice (2012). Vancomycin. The McGraw-Hill Companies, Inc. Retrieved on April 20, 2012 from http://www.harrisonspractice.com/practice/ub/view/DrugMonographs/156696/all/Vancomycin

Levison, M.E. (2009). Vancomycin. The Merck Manual: Merck Sharp & Dohme.

Retrieved on April 20, 2012 from http://www.merckmanuals.com/professionals/infections_diseases/bacteria_and_antibackterial_drugs/vancomycin.html

Medicine Net (2011). Vancomycin. Medicine Net. Retrieved on April 20, 2012 from http://www.medicinenet.com/vancomycin-oral/article.htm

Medscape Pharmacists (2007). The top 10 drug errors and how to prevent them.

Medscape Education: Medscape LLC. Retrieved on April 20, 2012 from http://www.medscape.com/viewarticle/556487

PDR (2012). Vancomycin HCL. Physician's Desk Reference: PDR Network LLC.

Retrieved on April 20, 2012 from http://www.pdr.net/drugpages/concisemonograph.aspx?concise=688.....

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