Vancomycin: Difference between revisions
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* Suspected or confirmed MRSA |
* Suspected or confirmed MRSA |
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| − | + | = Dosing = |
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* Common dose |
* Common dose |
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** 15-20 for high-risk infections such as osteomyelitis, meningitis, and bacteremia |
** 15-20 for high-risk infections such as osteomyelitis, meningitis, and bacteremia |
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| − | + | = Adverse Reactions = |
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| − | + | == Renal Failures == |
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* Risk factors |
* Risk factors |
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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 Man 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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* Histamine-mediated |
* Histamine-mediated |
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* Can decrease dose or prolong infusion, prophylactic antihistamines |
* Can decrease dose or prolong infusion, prophylactic antihistamines |
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| + | [[Category:Antibiotics]] |
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Revision as of 23:43, 14 August 2019
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
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 Man 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.
