Vancomycin - instructions for use, dose, side effects, contraindications

Forms a complex with acyl-D-alanine-D-alanine mucopeptide of the bacterial cell wall, inhibits its formation and increases permeability, disrupts synthesis RNA. It is active against aerobic Gram-positive microorganisms: Staphylococcus spp. (including Staphylococcus aureus and Staphylococcus epidermidis, including methicillin-resistant strains), Streptococcus spp., including Streptococcus bovis, Streptococcus viridans, Streptococcus pyogenes, Streptococcus pneumoniae (including strains resistant to penicillin), Streptococcus agalactiae, Listeria monocytogenes; anaerobic Gram-positive microorganisms: Actinomyces spp., Enterococcus spp. (including Enterococcus faecalis), Corynebacterium diphtheriae, Clostridium spp. In vitro Inactive against gram-negative microorganisms, mycobacteria, fungi, viruses, protozoa. There is no cross-resistance between vancomycin and other antibiotics. The optimum action is when pH 8, with a decrease pH up to 6 the effect is sharply reduced. Actively acts only on microorganisms, which are in the stage of reproduction.

Pharmacokinetics:

Poorly absorbed when taken orally. With intraperitoneal administration, systemic absorption is possible up to 60% (when administered at a dose of 30 mg / kg plasma concentration - about 10 mg / ml) for 6 hours. Binding to plasma proteins is 55%. After intravenous the therapeutic concentrations are determined in ascitic, synovial, pleural and pericardial fluids, peritoneal dialysate fluid, in the urine, atrial auricle tissue. Does not penetrate blood-brain barrier (with meningitis found in the cerebrospinal fluid in therapeutic concentrations). Penetrates through the placenta. Excreted in breast milk. Virtually not metabolized. Half-life from plasma with normal kidney function in adults - 4-6 hours, with chronic renal failure slows down, with anuria - up to 7.5 days. With repeated introduction, cumulation is possible. About 75% is excreted by the kidneys by glomerular filtration in the first 24 hours; in patients with a deleted or missing kidney is slowly withdrawn, and the removal mechanism is unknown. In small and moderate amounts can be excreted with bile. When administered orally, it is almost completely excreted with feces. In small amounts, it is excreted in hemodialysis or peritoneal dialysis.

Indications:

Infectious-inflammatory diseases heavy currents, caused by susceptible to vancomycin pathogens (in case of intolerance or failure of therapy with other antibiotics, including penicillins and cephalosporins), sepsis, endocarditis (as monotherapy or as part of combination antibiotic therapy), pneumonia, lung abscess, meningitis, bone infections and joints, skin and soft tissue infections. Pseudomembranous colitis caused by Clostridium difficile.

ICD-10

I.A00-A09.A04.7 Enterocolitis caused by Clostridium difficile

I.A30-A49.A40 Streptococcal septicemia

I.A30-A49.A41 Other septicemia

VI.G00-G09.G00 Bacterial meningitis, not elsewhere classified

IX.I30-I52.I33 Acute and subacute endocarditis

X.J10-J18.J15 Bacterial pneumonia, not elsewhere classified

X.J85-J86.J85 Abscess of the lung and mediastinum

XIII.M86-M90.M86 Osteomyelitis

Contraindications:

Neuritis of the auditory nerve, pronounced impaired renal function, I trimester of pregnancy, lactation (breastfeeding), hypersensitivity to vancomycin.

Carefully:

Use with caution for mild to moderate impairment of kidney function, hearing impairment (including history), in the second and third trimesters of pregnancy. During the treatment of patients with kidney disease and / or damage to the VIII pair of cranial nerves, it is necessary to monitor the function of the kidneys, hearing.

Pregnancy and lactation:

FDA Action Category - C.

The use in the first trimester of pregnancy is contraindicated because of the risk of developing nephro- and ototoxicity. The use of vancomycin in the II and III trimesters is possible only according to vital indications.

If it is necessary to use lactation, breastfeeding should be discontinued.

Dosing and Administration:

Enter intravenously drip. Adults-500 mg every 6 hours or 1 g every 12 hours. To avoid collapoid reactions, the duration of the infusion should be at least 60 minutes. Children - 40 mg / kg per day, each dose should be administered at least 60 minutes. In patients with impaired renal excretory function, the dose is reduced taking into account the values of creatinine clearance.

Depending on the etiology of the disease vancomycin can be taken internally. For adults, the daily dose is 0.5-2 g in 3-4 doses, for children - 40 mg / kg in 3-4 doses.

The maximum daily dose for adults with intravenous administration is 3-4 g.

Side effects:

From the cardiovascular system: heart failure, hot flashes, lowering blood pressure, shock (these symptoms are mainly associated with rapid infusion of drug substance).

On the part of the hematopoiesis system: neutropenia, eosinophilia, thrombocytopenia, agranulocytosis.

From the digestive system: nausea.

From the urinary system: interstitial nephritis, changes in functional renal tests, impaired renal function.

From the side sense organs: vertigo, ringing in the ears, ototoxic effects.

Dermatological reactions: exfoliative dermatitis, benign bubble dermatosis, itching dermatosis, rash.

Allergic reactions: urticaria, Stevens-Johnson syndrome, toxic epidermal necrolysis, vasculitis. During or soon after too rapid infusion of vancomycin, anaphylactoid reactions are possible.

Other: chills, drug fever, tissue necrosis at injection sites, pain at injection sites, thrombophlebitis. With rapid intravenous administration, it is possible to develop a "red neck syndrome" associated with the release of histamine: erythema, skin rash, reddening face, neck, upper body, hands, palpitations, nausea, vomiting, chills, fever, fainting.

Overdose:

Symptoms: increased severity of side effects.

Treatment: Symptomatic in combination with hemoperfusion and hemofiltration.

Interaction:

The simultaneous use of vancomycin and local anesthetics can lead to the development of erythema, histamine-like hot flashes and anaphylactic shock.

With the simultaneous use of vancomycin with aminoglycosides, amphotericin B, cisplatin, cyclosporine,furosemide, polymyxins, there is an increase in oto- and nephrotoxic action.

Special instructions:

Intramuscular administration of vancomycin is not allowed because of the high risk of tissue necrosis.

When used in newborns or elderly patients, it is necessary to monitor the concentration of vancomycin in the blood plasma.

Instructions

Vancomycin (Vancomycinum)