Section 15 · Monograph
Vancomycin
Reviewed Nov 2026FDA label
VancocinGlycopeptide
- Forms
- IV: 500mg, 1g, 1.5g, 5g, 10g vials
- Dose
- Meningitis (adjunct): 15-20mg/kg IV q8-12h, level/AUC-guided
- MOA
- Inhibits bacterial cell wall synthesis
Indications
- Serious gram-positive infections including MRSA and penicillin-resistant pneumococcal meningitis (adjunct to empiric bacterial meningitis therapy)FDA-labeled
- Oral vancomycin for C. difficile infectionFDA-labeled
Mechanism of Action
- Glycopeptide antibiotic that inhibits bacterial cell wall synthesis by binding D-Ala-D-Ala terminus of peptidoglycan precursors
Full Dosing
Adult / usual
- Empiric meningitis: 15-20mg/kg IV every 8-12 hours, guided by AUC/trough monitoring
- Infuse no faster than 10mg/min to avoid infusion reaction
Renal
- Adjust for renal function; intraventricular use is specialist-directed
Contraindications
- Hypersensitivity to vancomycin
Drug Interactions
- Aminoglycosides, piperacillin-tazobactam and loop diuretics increase nephrotoxicity and ototoxicity risk
- May potentiate neuromuscular blockers
Adverse Effects
- Vancomycin infusion reaction (flushing, rash, hypotension)
- Nephrotoxicity
- Ototoxicity
- Neutropenia with prolonged use
- Thrombophlebitis
Monitoring Parameters
- Serum level or AUC
- Serum creatinine at least 2-3 times weekly
- CBC
Pregnancy & Lactation
- Limited data; used when indicated
- Excreted in milk; poor oral absorption in infants