Vancomycin 125mg

Antibiotic, Glycopeptide

“ALERT: US Boxed Warning

​Risk of embryo-fetal toxicity due to excipients:

The formulation of vancomycin injection containing the excipients, polyethylene glycol (PEG 400) and N-acetyl D-alanine (NADA), is not recommended for use during pregnancy. PEG 400 and NADA have caused fetal malformations in animal reproduction studies. If use of vancomycin is needed during pregnancy, use other available formulations of vancomycin.”

CSA NA – FDA Approved – REMS (N) – Can Ship

Vancomycin, Vancocin/Firvanq/Vancosal inhibits bacterial cell wall synthesis by blocking glycopeptide polymerization through binding tightly to D-alanyl-D-alanine portion of cell wall precursor

Vancomycin, Vancocin/Firvanq/Vancosal is used on or off label for various infections depending on your common local bacterial strains for various infections and based on local resistance patterns.  Not all antibiotics work for all infections and efficacy can vary from area to area and vary with time.  It is officially indicated in North America for use in Clostridioides (formerly Clostridium) difficile infection (oral), Endocarditis Enterocolitis (oral), and Staphylococcal infections (injection).

Before starting Vancomycin, Vancocin/Firvanq/Vancosal make sure your physician is aware of any allergies or medications you currently take, if you have inflammatory bowel disease, kidney disease, if you are pregnant, or breastfeeding.  Vancomycin has been associated with rare but serious reactions such as thrombophlebitis, nephrotoxicity, neutropenia, ototoxicity, and superinfection by resistant organism.

Oral: Note: Ineffective for treating systemic infections: 125 to 500 mg 4 times daily.

IV: Note: Ineffective for treating C. difficile infections

Complex Dosing – Intermittent bolus 15-20mg/kg/dose every 8 to 12 hours then titrate – some patients may require a loading bolus dosage, and others may require a continuous IV infusion.

How to Take: Follow instructions provided by physician/pharmacy label, take consistently at same times each day unless otherwise directed, store at room temperature

Oral >10%:

Endocrine & metabolic: Hypokalemia (13%)

Gastrointestinal: Abdominal pain (15%), nausea (17%)

IV therapy is done under supervision however, rates of side effects have not been determined.

Note that this is not an extensive list of side effects, only the most common ones when taken orally.

1. Why would my physician prescribe an antibiotic that can cause a superinfection?
   Bacterial resistance is becoming more of an issue and not all antibiotics work for all bacteria.  Certain antibiotics concentrate in different parts of the body which can also affect which ones work in which situations.  Your physician takes the most recent clinical guidelines and follows local resistance patterns to make evidence-based decisions that are reviewed and agreed upon by the medical community as to what agents should be used in which types of infections.  Your current medications, your allergies, age, cost of medication, side effects you experience from various antibiotics and many other factors will further complicate or limit which medications are appropriate.  Broad spectrum antibiotics that kill many kinds of bacteria can eradicate your intestinal flora (good bacteria) which leaves your intestine resources available for new bacteria to grow.  Sometimes this is a particularly bad bacteria that normally would not get the opportunity but if it did survive the exposure to the broad spectrum antibiotic, it may have high levels of resistance to multiple agents hence a “superinfection”.  This decision was not made lightly, however if you are concerned, ask your physician to clarify why they made their choice of antibiotic and they can let you know why this was the best option for this scenario.