Glycopeptides · Anti-infectives
Vancomycin
Vancocin®(brand names vary by market)
The MRSA glycopeptide whose levels you will be asked about forever.
Also: capsule, oral liquid
Mechanism
Binds D-Ala-D-Ala termini of peptidoglycan precursors, blocking cell-wall synthesis in gram-positives; too large to cross gram-negative outer membranes.
Indications
- Serious MRSA infections (IV)
- Severe C. difficile colitis (oral: stays in the gut)
- Beta-lactam-allergic gram-positive coverage
Formulations
Dosing concepts
Two different drugs
IV vancomycin does nothing for C. difficile; oral vancomycin does nothing for bacteremia. Route is indication.
TDM
Dosed by weight, adjusted by level (AUC- or trough-guided) and renal function; the platform's TDM module practices exactly this.
Infusion rate
Infused over at least an hour; rapid infusion causes histamine-mediated flushing ('vancomycin infusion reaction'), which is rate, not allergy.
Concepts, not prescribing instructions. Practice numbers live in current references and local protocols.
Pharmacokinetics
- Half-life
- ~6-8 h (normal renal function)
- Elimination
- renal: Accumulates predictably as GFR falls. The reason for level-guided dosing
Adverse effects
- Nephrotoxicity (dose/level-related, worse with piperacillin-tazobactam or aminoglycosides)serious
- Infusion reaction (rate-related flushing)common
- Ototoxicity (rare, high levels)serious
Contraindications & precautions
Contraindications
- Previous severe hypersensitivity
Precautions
- Concurrent nephrotoxins
- Unstable renal function (levels move under your feet)
Interactions
Monitoring
Levels (AUC or trough per protocol)
The efficacy-toxicity window is navigated by number · Before the 4th-5th dose at steady state, earlier if renal function shifts
Serum creatinine
Both a cause and a consequence of wrong levels · At least every 2-3 days, daily if unstable
Counselling points
- For the oral form in C. difficile: finish the full course even as diarrhea improves.
Clinical pearls
- A rising creatinine on vancomycin is a level question before it is anything else.
References & review
- Vancomycin product monograph (consult the current version for your market) (monograph)
- Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed. (reference-work)
Last reviewed 2026-08-15 · jurisdiction: global · drug information changes; verify against current references before practice use.