Description

Simple

An antibiotic used to treat serious infections in the body.

Clinical

A glycopeptide antibiotic used to treat severe but susceptible bacterial infections such as MRSA (methicillin-resistant Staphylococcus aureus) infections.

Overview

Antibacterial obtained from Streptomyces orientalis. It is a glycopeptide related to ristocetin that inhibits bacterial cell wall assembly and is toxic to kidneys and the inner ear.

As of January 29 2018, CutisPharma's Firvanq is the only FDA approved vancomycin oral liquid treatment option available for the the treatment of _Clostridium difficile_ associated diarrhea and enterocolitis caused by _Staphylococcus aureus_, including methicillin-resistant strains [LP1196]. Such an oral liquid formulation is expected to make _Clostridium difficile_ associated diarrhea therapy more accessible in comparison to previously available specialty compounding products [LP1196].

Pharmacology

Indication

A variety of dosage forms (for example, oral, injections, etc.) exist for the treatment of serious or severe infections caused by susceptible strains of methicillin-resistant (beta-lactam-resistant) staphylococci [FDA Label].

Additionally, a unique FDA approved oral liquid treatment is also avail... Read more

Pharmacodynamic

Vancomycin is a branched tricyclic glycosylated nonribosomal peptide often reserved as the "drug of last resort", used only after treatment with other antibiotics has failed. Vancomycin has been shown to be active against most strains of the following microorganisms, both in vitro and in clinical in... Read more

Mechanism of action

The bactericidal action of vancomycin results primarily from inhibition of cell-wall biosynthesis. Specifically, vancomycin prevents incorporation of N-acetylmuramic acid (NAM)- and N-acetylglucosamine (NAG)-peptide subunits from being incorporated into the peptidoglycan matrix, which forms the majo... Read more

Absorption

Poorly absorbed from gastrointestinal tract, however systemic absorption (up to 60%) may occur following intraperitoneal administration [FDA Label].

Protein binding

Approximately 50% serum protein bound [ Read more

Volume of distribution

The volume of distribution, as discussed in the literature, varies between 0.4-1 L/kg [6].

Clearance

The mean plasma clearance of vancomycin is about 0.058 L/kg/h [FDA Label].

Half life

Half-life in normal renal patients is approximately 6 hours (range 4 to 11 hours). In anephric patients, the average half-life of elimination is 7.5 days [FDA Label].

Route of elimination

In the first 24 hours, about 75-80% of an administered dose of vancomycin is excreted in urine by glomerular filtration [FDA Label, Read more

Toxicity

The oral LD50 in mice is 5000 mg/kg. The median lethal intravenous dose is 319 mg/kg in rats and 400 mg/kg in mice. [FDA Label]

Conversely, the most common adverse effects associated with vancomycin appear to be nausea, abdominal pain, and hypokalemia [FDA Label]. In particular, incide... Read more

Adverse Effects

Contraindications

Information currently not available.

Food Interactions

  • Take with or without food.

Interactions

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  • Paracetamol(acetaminophen)
  • Paxil(paroxetine)
  • Pamelor(nortriptyline)
  • Panadol(acetaminophen)
  • Patanol(olopatadine ophthalmic)
  • Pataday(olopatadine ophthalmic)
  • Parnate(tranylcypromine)
  • Pazeo(olopatadine ophthalmic)
(R)-warfarin
The risk or severity of bleeding can be increased when Vancomycin is combined with (R)-warfarin.
(S)-Warfarin
The risk or severity of bleeding can be increased when Vancomycin is combined with (S)-Warfarin.
4-hydroxycoumarin
The risk or severity of bleeding can be increased when Vancomycin is combined with 4-hydroxycoumarin.
Abacavir
Abacavir may decrease the excretion rate of Vancomycin which could result in a higher serum level.
Acarbose
Acarbose may decrease the excretion rate of Vancomycin which could result in a higher serum level.
Aceclofenac
Aceclofenac may decrease the excretion rate of Vancomycin which could result in a higher serum level.
Acemetacin
Acemetacin may decrease the excretion rate of Vancomycin which could result in a higher serum level.
Acenocoumarol
The risk or severity of bleeding can be increased when Vancomycin is combined with Acenocoumarol.
Acetaminophen
Acetaminophen may decrease the excretion rate of Vancomycin which could result in a higher serum level.
Acetazolamide
Acetazolamide may increase the excretion rate of Vancomycin which could result in a lower serum level and potentially a reduction in efficacy.
Acetylsalicylic acid
Acetylsalicylic acid may decrease the excretion rate of Vancomycin which could result in a higher serum level.
Aclidinium
Aclidinium may decrease the excretion rate of Vancomycin which could result in a higher serum level.
Acrivastine
Acrivastine may decrease the excretion rate of Vancomycin which could result in a higher serum level.
Acyclovir
Acyclovir may decrease the excretion rate of Vancomycin which could result in a higher serum level.
Adefovir
Adefovir may decrease the excretion rate of Vancomycin which could result in a higher serum level.
Adefovir dipivoxil
Adefovir dipivoxil may decrease the excretion rate of Vancomycin which could result in a higher serum level.
Albutrepenonacog alfa
Albutrepenonacog alfa may decrease the excretion rate of Vancomycin which could result in a higher serum level.
Alclofenac
Alclofenac may decrease the excretion rate of Vancomycin which could result in a higher serum level.
Alcuronium
The therapeutic efficacy of Alcuronium can be increased when used in combination with Vancomycin.
Aldesleukin
Aldesleukin may decrease the excretion rate of Vancomycin which could result in a higher serum level.
9 References
  1. 1 . Levine DP: Vancomycin: a history. Clin Infect Dis. 2006 Jan 1;42 Suppl 1:S5-12.PubMed: 16323120
  2. 2 . Small PM, Chambers HF: Vancomycin for Staphylococcus aureus endocarditis in intravenous drug users. Antimicrob Agents Chemother. 1990 Jun;34(6):1227-31.PubMed: 2393284
  3. 3 . Gonzalez C, Rubio M, Romero-Vivas J, Gonzalez M, Picazo JJ: Bacteremic pneumonia due to Staphylococcus aureus: A comparison of disease caused by methicillin-resistant and methicillin-susceptible organisms. Clin Infect Dis. 1999 Nov;29(5):1171-7.PubMed: 10524959
  4. 4 . Sivagnanam S, Deleu D: Red man syndrome. Crit Care. 2003 Apr;7(2):119-20. Epub 2002 Dec 23.PubMed: 12720556
  5. 5 . Cantu TG, Yamanaka-Yuen NA, Lietman PS: Serum vancomycin concentrations: reappraisal of their clinical value. Clin Infect Dis. 1994 Apr;18(4):533-43.PubMed: 8038306
  6. 6 . Rybak MJ: The pharmacokinetic and pharmacodynamic properties of vancomycin. Clin Infect Dis. 2006 Jan 1;42 Suppl 1:S35-9. doi: 10.1086/491712.PubMed: 16323118
  7. 7 . Butterfield JM, Patel N, Pai MP, Rosano TG, Drusano GL, Lodise TP: Refining vancomycin protein binding estimates: identification of clinical factors that influence protein binding. Antimicrob Agents Chemother. 2011 Sep;55(9):4277-82. doi: 10.1128/AAC.01674-10. Epub 2011 Jun 13.PubMed: 21670191
  8. 8 . Matzke GR, Zhanel GG, Guay DR: Clinical pharmacokinetics of vancomycin. Clin Pharmacokinet. 1986 Jul-Aug;11(4):257-82. doi: 10.2165/00003088-198611040-00001.PubMed: 3530582
  9. 9 . CutisPharma Announces FDA Approval of Firvanq (vancomycin) for Treatment of Clostridium Difficile Associated Diarrhea and Staphylococcus Aureus Colitis Link