Vancomycin (Oral)

Generic name:

Vancomycin (Oral)

Drug class:

Glycopeptide antibiotic

Dosage form:

Capsules; Powder for oral solution

Route of administration:

Oral

Dose:

• Adults: 125–500 mg orally every 6 hours; typical C. difficile: 125 mg QID for 10–14 days
• Pediatric: 10 mg/kg (max 500 mg) QID for 10–14 days
• Severe or recurrent cases: up to 500 mg QID or tapered/pulsed regimens
• Varies by indication; consult label.

Mechanism of action:

Binds to D-Ala-D-Ala terminus of peptidoglycan precursors, inhibiting bacterial cell wall synthesis and leading to cell lysis.

Drug usage cases:

• Clostridioides difficile-associated diarrhea and colitis
• Enterocolitis caused by Staphylococcus aureus (including MRSA)
• Prophylaxis of C. difficile recurrence (tapered regimens)
• Small intestinal bacterial overgrowth (off-label)
• Prophylaxis in neutropenic patients (off-label)
• Varies by indication; consult label.

Drug contra indications:

• Hypersensitivity to vancomycin or other glycopeptides
• Varies by indication; consult label.

Side effects:

• Gastrointestinal: nausea, vomiting, abdominal pain, flatulence
• Clostridioides difficile infection or superinfection
• Neutropenia, leukopenia
• Thrombocytopenia
• Ototoxicity (rare; with systemic absorption)
• Nephrotoxicity (rare with oral; increased risk if systemic absorption)
• “Red man” syndrome (histamine-mediated flushing, pruritus)
• Anaphylactoid reactions (rare)
• Skin reactions: rash, urticaria, Stevens-Johnson syndrome (rare)
• Biliary and hepatic: transient increases in liver enzymes

Warnings:

• Risk of Clostridioides difficile–associated diarrhea with broad-spectrum antibiotic use
• Monitor for superinfections (bacterial or fungal)
• Risk of “red man” syndrome with rapid infusion (IV); oral use has minimal systemic infusion risk but caution if mucosal damage
• Use with caution in patients with severe renal impairment or on hemodialysis (absorption may increase)
• Monitor blood counts during prolonged therapy
• May cause hypersensitivity reactions; have emergency measures available
• Varies by indication; consult label.

Use during pregnancy or breastfeeding:

Pregnancy Category B: animal studies show no teratogenic effects; human data limited. Use only if clearly needed.

Breastfeeding: excreted in breast milk in low concentrations; monitor infant for gastrointestinal disturbance or sensitization. Consider risk vs benefit.