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Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

VANCOMYCIN

Indication

  • for the treatment of documented or suspected methicillin resistant (coagulase negative) S. epidermidis, also methicillin resistant S. aureus (IV only)
  • for the treatment of necrotizing enterocolitis (NEC) which is caused by Clostridium difficile (IV and/or po) (to widen spectrum of coverage a parenteral 3rd generation cephalosporin may be added)

Pharmacology

  • vancomycin is a tricyclic glycopeptide antibiotic with a complex structure that is unrelated to any other commercially available antibiotic
  • vancomycin is bactericidal; it appears to act by inhibiting cell wall synthesis
  • vancomycin is active against many Gram-positive organisms; it is NOT active against Gram-negative organisms, fungi or yeast
  • vancomycin is usually not appreciable absorbed from the GI tract
  • the majority (80 to 90%) of an IV dose is eliminated unchanged in the urine; when given orally, most of vancomycin is excreted in the stool
  • target trough (pre) level: 10 to 20 mg/L
  • 0.25mL of blood is required for the assay

Side Effects

  • ototoxicity and nephrotoxicity CAN BE POTENTIATED BY CO-ADMINISTRATION OF AN AMINOGLYCOSIDE
  • very irritating to tissues; avoid extravasation, since vancomycin can cause necrosis
  • can also cause chills, fever, urticaria, macular rash, and hematologic reactions (eg. neutropenia)

Miscellaneous

  • although it is not recommended that medications and TPN (amino acid/dextrose) mixture and lipid be mixed, in some situations there is no alternative. A vancomycin infusion has successfully (no evidence of physical incompatibility) been "y'd" in with a mixture of amino acid/dextrose and lipid in this unit. In all instances, however, the IV lines should be carefully inspected for any signs of incompatibility (precipitate, change in color, haze)
  • vancomycin has now been found to be compatible with various amino acid/dextrose mixtures
  • a trough (pre) vancomycin level should be taken prior to the 4th dose if treatment is planned for more than 48 hours
  • a post level is reasonable when a baby is being treated for CNS infection

Dose

  • administer by slow IV infusion over 30 minutes. The manufacturer suggests that a 60 minute infusion is preferable, but 30 minutes is the MINIMAL acceptable duration of infusion

Vancomycin Dosing for NICU:

Day of Life

Post Menstrual Age (Corrected Age)

 Dose & frequency

0-28

Less than 30 weeks

10 mg/kg IV q12h

30 weeks or greater

10 mg/kg IV q8h

     

Greater than 28

Less than 30 weeks

10 mg/kg IV q8h

30 weeks to less than 40 weeks

15 mg/kg IV q8h

40 weeks or greater

15 mg/kg IV q6h

  • THE PHYSICIAN SHOULD BE AWARE OF THE INCREASED FLUID INTAKE AND SHOULD ADJUST THE FLUID MANAGEMENT (INCLUDING TPN) OF THE INFANT ACCORDINGLY.
  • oral dose: 10 mg/kg q6-8h
  • oral use is for local (GI) effect only. Normally it is not appreciably absorbed from the GI tract
  • Pharmacy will prepare a vancomycin solution in a bottle for oral use. If the order is written while the Pharmacy is closed the nurse may use a vial (5 mg/mL) that is wardstock and label "FOR ORAL USE ONLY."
  • if there is no 5 mg/mL solution in the unit, and the Pharmacy is closed, a 500 mg vial of vancomycin (unreconstituted) may be obtained from the night cupboard. Follow these instructions to produce a 5 mg/mL solution:
    1. Inject 10 mL sterile water for injection (SWFI) into the vial to produce a concentration of 50 mg/mL
    2. Inject 1 mL of the 50 mg/mL solution into a 20 mL syringe
    3. Add 9 mL SWFI to the 20 mL syringe
      .. concentration is 50 mg/10mL
      = 5 mg/mL

Supplied

  • 5 mg/mL syringe prepared by Department of Pharmacy
  • 5 mg/mL vial, prepared by Department of Pharmacy; this vial may be kept for 24h (in the refrigerator) after the first puncture

500 mg vial (unreconstituted powder)

References

  1. Personal Communication. Ronald Fehst, Medical Information Co-Ordinator, Eli Lilly Inc, Canada, November 1986.
  2. McEvoy G K (ed): AHFS Drug Information, American Society of Hospital Pharmacists, 1991.
  3. Schilling CG, Watson DM, McCoy HG and Uden DL: Stability and delivery of vancomycin hydrochloride when admixed in a total parenteral nutrition solution, Journal of Parenteral and Enteral Nutrition 1989; 13:63-64
  4. Taketomo CK, Hodding JH and Kraus DM: Pediatric Dosage Handbook, Lexi-Comp Inc., Cleveland, 1992.
  5. Taeusch WH Ballard RA and Avery ME (ed): Schaffer and Avery's Diseases of the Newborn, WB Saunders Co, Toronto, Ontario; 6th Edition, 1991.
  6. Young TE and Mangum OB: Neofax - A Manual of Drugs Used in Neonatal Care, Columbus, Ohio: Ross Laboratories, 1992.



Last Updated: Wednesday, 23-March-2016 09:28 EDT
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