Vancomycin instructions for use
Vancomycin is an antibacterial drug of the glycopeptide group that has a bactericidal effect on gram-positive bacteria. It is used in the treatment of severe forms of infectious pathologies, as well as intolerance or ineffectiveness of antibacterial drugs of other groups.
Release form and composition
Vancomycin is produced in the form of a dry powder (lyophilisate) 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 box. Another dosage form of Vancomycin is tablets.
The main active ingredient is vancomycin (in the form of hydrochloride).
Pharmacodynamics. Vancomycin belongs to the antibacterial drugs of the group of glycopeptides (high-molecular carbohydrate-containing antibiotics). It 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 - staphylococcus (including penicillin-forming and methicillin-resistant strains), streptococci, enterococci, corynebacteria, listerias, actinomycetes, clostridia. Affects the bacterial cells which are in a reproduction stage. Vancomycin does not have a detrimental effect on gram-negative bacteria, mycobacteria and fungi, viruses, protozoa.
Cross-resistance of vancomycin with antibacterial drugs of other groups was not detected.
Pharmacokinetics. The optimal therapeutic effect of vanomycin is observed at pH 8, at pH 6, the effect of the antibiotic is sharply reduced. Distributed in almost all fluids and tissues of the body. 55% of the active substance is bound to blood proteins. The time to reach the maximum concentration of vancomycin in the blood plasma is 30–60 minutes.
The elimination half-life is: in newborns - from 6 to 10 hours, in infants - 4 hours, in older children - 2-3 hours, in adults - an average of 6 hours (from 4 to 11), and in renal failure - 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 increases sharply with inflammation of the meninges). It penetrates the placental barrier.
Indications for use
The 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 inflammations of the central nervous system;
- pneumonia (pneumonia);
- lung abscess;
- infectious pathologies of bone tissue and joints, including osteomyelitis ;
- infectious inflammation of the skin and soft tissues;
- pseudomembranous colitis (the causative agent of Clostridium difficile) and staphylococcal enterocolitis (use the powder inside or tablets).
Vancomycin is also used in cases of intolerance or lack of a positive therapeutic effect during treatment with other antibiotic groups - penicillins and cephalosporins.
Absolute contraindications to the use of Vancomycin are:
- pronounced functional disorders of the kidneys;
- neuritis of the auditory nerve;
- I trimester of pregnancy and breastfeeding period;
- hypersensitivity or individual intolerance to 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 administered drip 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 increases the risk of collaptoid reactions).
Vancomycin Dosages for Intravenous Administration
For adults, a single dosage is 500 mg with the introduction every 6 hours or 1 g with the introduction every 12 hours. The maximum allowable daily intake for adults is 3-4 g.
For newborns in the first week of life, vancomycin is administered at an initial dose of 15 mg / kg, then 10 mg / kg every 12 hours. From the 8th day of the infant's life, the 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.
For preparing an infusion solution, the powder is dissolved in water for injection: 500 mg in 10 ml, 1 g in 20 ml (solution concentration 50 mg / ml). The resulting solution is diluted with 0.9% sodium chloride solution or 5% dextrose solution: for 500 mg - 100 ml of solution, for 1 g - 200 ml. The concentration of the prepared solution should not exceed 5 mg / ml.
Dosage for oral administration (with enterocolitis and pseudomembranous colitis)
For adults, the recommended single dose ranges from 500 mg to 2 g, for children - 40 mg / kg. The frequency 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 use of Vancomycin, undesirable side effects may occur:
- on the part of the cardiovascular system - lowering blood pressure, hot flashes, cardiac arrest, shock (most often occur with the rapid intravenous administration of an antibiotic);
- on the part of the hematopoietic system - agranulocytosis (rare), 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;
- on the part of the excretory system - interstitial nephritis, functional disorders of the kidneys, nephrotoxicity, which can turn into renal failure;
- on the part of the hearing organs - ringing in the ears, vertigo, impairment of hearing;
- allergic reactions - rash, including exfoliative dermatitis, toxic epidermal necrolysis, urticaria , vasculitis ;
- local reactions - pain or tissue necrosis at the injection sites, thrombophlebitis (more often due to violation of the rules of solution administration).
With the rapid introduction of the solution can be observed "red neck syndrome" (manifested by redness of the skin of the face and upper body), skin rash, muscle spasm in the back and neck, anaphylactoid reactions (increased heart rate, fever, bronchospasm, lowering blood pressure, dizziness).
In case of overdose of Vancomycin, aggravation of the side effects of the drug is noted. Symptomatic agents are prescribed for treatment, hemoperfusion and hemofiltration are performed.
When using antibiotics, it is important to consider:
- before prescribing, the sensitivity of the organism to the active substance must be determined;
- Vancomycin is used with caution in mild and moderate functional impairment of the kidneys (the dose is reduced in accordance with creatinine clearance) and is contraindicated in severe functional renal impairment;
- prescribed with caution for hearing impairment;
- during the period of treatment should be audiogram, determination of renal function (urinalysis, determination of creatinine and urea nitrogen);
- control of the level of vancomycin in the blood plasma is required during the treatment of newborns and the elderly, patients with impaired renal function.
- Vancomycin in combination with general anesthetics can cause the development of erythema, histamine-like flushing, anaphylactic shock;
- the combination of Vancomycin with amphotercin B, cisplatin, aminoglycosides, diuretics, cyclosporine, polymyxins intensifies the side effects of the kidneys and organs of hearing, up to severe kidney damage and loss of hearing;
- cholesteramine lowers the effectiveness of vancomycin;
- Vancomycin is not compatible with corticosteroids, heparin, chloramphenicol, aminophylline, phenobarbital, therefore their simultaneous use is not recommended;
- do not mix vancomycin solution with any other medicinal solutions.
Pregnancy and lactation:
- Vancomycin is contraindicated in the first trimester of pregnancy because of the high risk of a toxic effect on the kidneys and hearing system;
- in the II and III trimesters, an antibiotic can be prescribed only for health reasons, in situations where the expected benefit to the mother outweighs the potential risks to the fetus;
- when using the drug during lactation, breast feeding of the infant should be discontinued.
The structural analogues of the drug, which include vancomycin, include: Vancoled, Teva Vancomycin, Vancotsin, Vanmiksan, Vero-Vancomycin, Vancomycin Qualimed, Editsin, Vancomabol, Vankorus.
Terms and conditions of storage
Vancomycin is stored in a dry place, protected from sunlight, at room temperature (below 25 ° C). Shelf life is 2 years. Do not use an antibiotic after the expiration date indicated on the package.
Vancomycin powder - 200-280 rubles.