Vancomycin: Difference between revisions
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== Adverse Reactions == |
== Adverse Reactions == |
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* Primarily include [[Adverse drug reaction::renal failure]] and [[Adverse drug reaction::red person syndrome]] |
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=== Renal Failures === |
=== Renal Failures === |
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* Risk factors |
* Risk factors |
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** Prolonged courses >21 days |
** Prolonged courses >21 days |
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* Mechanism of injury: oxidative stress in the proximal tubular cells |
* Mechanism of injury: oxidative stress in the proximal tubular cells |
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=== Red |
=== Red Person Syndrome === |
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* Rash, pruritis, and hypotension, with onset of vancomycin, resolves on stopping |
* Rash, pruritis, and hypotension, with onset of vancomycin, resolves on stopping |
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* Very high incidence previously |
* Very high incidence previously |
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Revision as of 03:17, 18 February 2020
Indications
- Suspected or confirmed MRSA
Dosing
- Common dose
- 15mg/kg/dose with timing based on renal function (q12h if normal)
- Titrate based on serum trough drawn within hour before fourth dose
- Target trough
- 10-15 for low-risk infections
- 15-20 for high-risk infections such as osteomyelitis, meningitis, and bacteremia
Adverse Reactions
- Primarily include renal failure and red person syndrome
Renal Failures
- Risk factors
- Prolonged courses >21 days
- Higher trough
- Concomitant nephrotoxic medication
- Older age
- CKD/AKI
- Liver disease
- Peritonitis
- Neutropenia
- Male sex
- Mechanism of injury: oxidative stress in the proximal tubular cells
Red Person Syndrome
- Rash, pruritis, and hypotension, with onset of vancomycin, resolves on stopping
- Very high incidence previously
- Histamine-mediated
- Can decrease dose or prolong infusion, prophylactic antihistamines
References
- ^ Michael J Rybak, Jennifer Le, Thomas P Lodise, Donald P Levine, John S Bradley, Catherine Liu, Bruce A Mueller, Manjunath P Pai, Annie Wong-Beringer, John C Rotschafer, Keith A Rodvold, Holly D Maples, Benjamin M Lomaestro. Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: A revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists. American Journal of Health-System Pharmacy. 2020. doi:10.1093/ajhp/zxaa036.
