Vancomycin
Glycopeptide antibiotic
Inhibits cell wall synthesis (binds D-Ala-D-Ala). Active against MRSA + gram-positives.
Indications
- •MRSA prophylaxis (cardiac, ortho implants, β-lactam allergy)
- •C. diff (PO)
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| Surgical prophylaxis | 15 mg/kg IV over ≥ 60 min (max 2 g) | 15 mg/kg IV over ≥ 60 min |
Pharmacokinetics
Onset 30 min. Half-life 4–6 h. Renal excretion (dose-adjust in CKD).
Side effects
- !Vancomycin-induced flushing (formerly 'Red Man Syndrome') — histamine release from rapid infusion (slow it down)
- !Nephrotoxicity (especially with NSAIDs, contrast, gentamicin)
- !Ototoxicity (high serum levels)
- !Linear IgA bullous dermatosis (rare)
Contraindications
- ×Documented vancomycin anaphylaxis (rare)
Clinical pearls
- ★Slow infusion (≥ 60 min) prevents most flushing reactions.
- ★Start at incision − 60 min so full dose in by skin opening.
- ★Trough monitoring not relevant for surgical prophylaxis.
Education only — confirm against current package inserts and institutional protocols. Doses assume normal organ function unless otherwise noted.