USMLE

Vancomycin

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Anti-Infective Drugs
  1. Vancomycin
  2. Metronidazole
  3. Penicillins
  4. Cephalosporins
  5. Macrolides
  6. Fluoroquinolones
  7. Aminoglycosides
  8. Tetracyclines
  9. Sulfonamides
  10. Rifampin
  11. Isoniazid
  12. Ethambutol
  13. Chloroquine
  14. Acyclovir
  15. Oseltamivir
  16. Azoles
  17. Nystatin
  18. Amphotericin B

Summary

Vancomycin is an antibiotic used to treat MRSA and C. Diff., among other bacterial infections. It has a narrow therapeutic range of 10-20 mcg/mL, so vancomycin drug levels will need to be checked periodically during treatment. Signs that vancomycin drug levels are too high include ototoxicity and nephrotoxicity. And lastly, if vancomycin is infused too quickly, it can cause red man syndrome, so be sure to infuse the drug over at least 60 minutes.

Key Points

  • Vancomycin (Vancocin)
    • Mechanism
      • Antibiotic
        • Glycopeptide
          • Inhibits bacterial cell wall synthesis
        • Broad-spectrum
    • Clinical Use
      • Bacterial Infection
        • Drug of choice for MRSA (IV form) and C. diff. (oral form)
        • Bacteremia/septicemia
        • Endocarditis
        • Respiratory, skin, and bone infections
    • Side Effects and Adverse Reactions
      • Normal therapeutic trough level is 10-20 mcg/mL.
        • Elevated vancomycin trough levels are associated with nephrotoxicity and ototoxicity
          • Monitor levels by checking peak 1 hour after infusion, trough just before the next dose. 
      • Nephrotoxicity
        • Monitor creatinine and BUN levels
      • Ototoxicity
      • Red man syndrome
        • Red skin discoloration of face, neck, arms, upper body, and back that occurs when vancomycin is infused too rapidly
        • IV infusions must be given over a minimum of 60 minutes
      • IV phlebitis near injection site
      • GI distress - nausea, vomiting, diarrhea
      • Peripheral edema
      • Hypokalemia