Vancomycin instructions for use
Vancomycin is an antibacterial preparation of a group of glycopeptides, which has a bactericidal effect on gram-positive bacteria. It is used in the therapy of severe forms of infectious pathologies, as well as with intolerance or ineffectiveness of antibacterial drugs of other groups.
Form of issue and composition
Vancomycin is released in the form of a dry powder (lyophilizate) for the preparation of an infusion solution, in dosages of 500 mg and 1000 mg, in vials. Each bottle with the instruction is placed in a cardboard package. Another dosage form of Vancomycin is tablets.
The main active ingredient is vancomycin (in the form of hydrochloride).
Pharmacodynamics. Vancomycin refers to antibacterial drugs of the glycopeptide group (high molecular weight hydrocarbon-containing antibiotics). Has a bactericidal effect by disrupting the synthesis of the cell wall, reducing the permeability of cytoplasmic membranes and suppressing the synthesis of ribonucleic acids of bacterial cells.
It is active against aerobic gram-positive bacteria - staphylococci (including penicillinase-forming and methicillin-resistant strains), streptococci, enterococci, corynebacteria, listeria, actinomycetes, clostridia. It acts on bacterial cells that are in the stage of reproduction. Vancomycin does not have a detrimental effect on gram-negative bacteria, mycobacteria and fungi, viruses, protozoan microorganisms.
Cross-resistance of vancomycin with antibacterial drugs of other groups was not revealed.
Pharmacokinetics. Optimum therapeutic effect of vanomycin is observed at pH 8, at pH 6 the antibiotic effect is sharply reduced. It is distributed practically over all liquids and tissues of the body. 55% of the active substance binds to blood proteins. The time to reach the maximum concentration of vancomycin in the blood plasma is 30-60 minutes.
The half-life period is: for newborns - from 6 to 10 hours, for infants - 4 hours, for older children - 2-3 hours, for adults - for an average of 6 hours (from 4 to 11), with renal insufficiency - from 6 Up to 10 days. Vancomycin is practically not metabolized. 80-90% of vancomycin is excreted by the kidneys, a small amount - with bile. Through the blood-brain barrier penetrates poorly (permeability sharply increases with inflammation of the meninges). Penetrates through the placental barrier.
Indications for use
Antibiotic Vancomycin is prescribed for the treatment of severe infectious and inflammatory pathologies caused by strains of microorganisms that are sensitive to the action of the drug. It:
- Meningitis and other infectious inflammation of the central nervous system;
- Inflammation of the lungs (pneumonia);
- Abscess of the lungs;
- Infectious pathologies of bone tissue and joints, including osteomyelitis ;
- Infectious inflammation of the skin and soft tissues;
- Pseudomembranous colitis (causative agent of Clostridium difficile) and staphylococcal enterocolitis (use powder inwards or tablets).
Also, Vancomycin is used when intolerance or the absence of a positive therapeutic effect during treatment with other groups of antibiotics - penicillins, cephalosporins.
Absolute contraindications to the use of Vancomycin are:
- Marked functional impairment of kidney function;
- Neuritis of the auditory nerve;
- I trimester of pregnancy and the period of breastfeeding;
- Hypersensitivity or individual intolerance of the components of the drug.
Dosing and Administration
Vancomycin can be used alone or as part of combination antibiotic therapy.
The solution of vancomycin is injected intravenously. The recommended concentration is not more than 5 mg / ml. The time of administration is at least one hour, the speed is no more than 10 mg / min. (With an increase in the rate of administration, the risk of collapoid reactions increases).
Dosages of Vancomycin for intravenous administration
For adults, a single dosage is 500 mg when administered every 6 hours or 1 g when administered every 12 hours. The maximum permissible daily intake for adults is 3-4 g.
Newborns in the first week of life Vancomycin is administered at an initial dose of 15 mg / kg, followed by 10 mg / kg every 12 hours. From the 8th day of the baby's life, an antibiotic at a dose of 10 mg / kg is administered every 8 hours. For children older than one month, a single dose should be 10 mg / kg every 6 hours or 20 mg / kg every 12 hours. The maximum daily dose is not more than 40 mg / kg.
To prepare the infusion solution, the powder dissolves in water for injection: 500 mg in 10 ml, 1 g in 20 ml (concentration of the solution 50 mg / ml). The resulting solution is diluted with 0.9% sodium chloride solution or 5% dextrose solution: for 500 mg - 100 ml solution, for 1 g - 200 ml. The concentration of the finished solution should not be more than 5 mg / ml.
Dosages for oral administration (with enterocolitis and pseudomembranous colitis)
For adults, the recommended single dose is 500 mg to 2 g, for children 40 mg / kg. Multiplicity of admission - 3-4 times a day, the duration of treatment - from a week to 10 days. To prepare the solution, the required dose of the powder is diluted in 30 ml of water.
During the application of Vancomycin, undesirable side effects may occur:
- From the cardiovascular system - lowering of arterial pressure, hot flashes, cardiac arrest, shock (often occur with rapid intravenous injection of antibiotic);
- On the part of the hematopoiesis system - agranulocytosis (rarely), reversible eosinophilia, thrombocytopenia, neutropenia;
- On the part of the digestive system - a feeling of bitterness in the oral cavity, diarrhea, nausea and vomiting, pseudomembranous colitis;
- From the excretory system - interstitial nephritis, functional disorders of the kidneys, nephrotoxicity, which can turn into renal failure;
- From the organs of hearing - ringing in the ears, vertigo, deterioration of hearing;
- Allergic reactions - a rash, including exfoliative dermatitis, toxic epidermal necrolysis, hives , vasculitis ;
- Local reactions - pain syndrome or tissue necrosis at the injection site, thrombophlebitis (more often due to a violation of the rules for administering the solution).
With rapid administration of the solution, "red neck syndrome" (manifested by reddening of the face and upper body), skin rash, muscle spasms in the back and neck region, anaphylactoid reactions (rapid heart rate, fever, bronchospasm, lowering of blood pressure, dizziness) can be noted.
In case of an overdose of Vancomycin, the side effects of the drug are aggravated. Symptomatic agents are prescribed for treatment, hemoperfusion and haemofiltration are performed.
When using an antibiotic, it is important to consider:
- Before prescribing the drug, the sensitivity of the organism to the active substance must be determined;
- Vancomycin with caution is used for mild and moderate functional impairment of kidney function (the dose decreases in accordance with the creatinine clearance rate) and is contraindicated in severe functional renal impairment;
- With caution is prescribed for hearing impairment;
- During the treatment should be audiogram, the definition of kidney function (urine analysis, determination of indicators of creatinine and urea nitrogen);
- During treatment of newborns and the elderly, patients with impaired renal function require monitoring of the level of vancomycin in blood plasma.
- Vancomycin in combination with general anesthetics can cause the development of erythema, histamine-like hot flashes, anaphylactic shock;
- Combination of Vancomycin with amphotericin B, cisplatinum, aminoglycosides, diuretics, cyclosporine, polymyxins increases side effects from the kidneys and hearing organs, up to severe kidney damage and hearing loss;
- Cholesterol lowers the effectiveness of Vancomycin;
- Vancomycin is not compatible with corticosteroids, heparin, chloramphenicol, aminophylline, phenobarbital, therefore their simultaneous use is not recommended;
- It is impossible to mix a solution of vancomycin with any other medicinal solutions.
Pregnancy and lactation:
- In the first trimester of pregnancy, Vancomycin is contraindicated because of the high risk of toxic effects on the kidney and hearing system;
- In the II and III trimesters, an antibiotic can be prescribed only for life indications, in situations where the expected benefit to the mother exceeds the potential risks to the fetus;
- When using the drug during lactation, breastfeeding of the infant should be discontinued.
The structural analogues of the drug, which include vancomycin, include: Vancolide, Vancomycin Teva, Vankocin, VanMixan, Vero-Vancomycin, Vancomycin Kvalimed, Edicin, Vancomabol, Vancorus.
Terms and conditions of storage
Vancomycin is stored in a dry, sheltered from sunlight place, at room temperature (below 25 ° C). Shelf life is 2 years. Do not use an antibiotic after the end of the shelf life indicated on the package.
Vancomycin powder - 200-280 rub.