Glycopeptide active against gram+ (incl. MRSA)
Vancomycin (oral capsules) is an antibiotic used to treat diarrhoea associated with Clostridioides difficile infection and enterocolitis caused by Staphylococcus aureus, including resistant strains. Taken orally, it acts in the gut without being absorbed into the blood. It is not effective for other types of infection by this route.
Also known as: Vancocina, Vancocin
Combining Tobramycin with Vancomycin increases the risk of nephrotoxicity and ototoxicity through an additive effect on the kidney and the inner ear.
Vancomycin and tobramycin (an aminoglycoside) have overlapping nephro- and ototoxicity: the vancomycin label warns that "systemic exposure may result in acute kidney injury" and the tobramycin label that aminoglycosides "have an inherent potential for causing ototoxicity and nephrotoxicity", with "aminoglycoside-induced hearing loss increasing with the degree of exposure to either high peak or high trough serum concentrations". The nephrotoxicity of the combination is well documented and the risk increases with pre-existing renal impairment, hypovolaemia, prolonged use or high doses. Monitor creatinine and urine output, vancomycin and tobramycin levels, and hearing/balance; adjust doses to creatinine clearance and limit the duration of combined therapy.
Vancomycin + tobramycin: overlapping and additive nephro- and ototoxicity. Monitor renal function, levels and hearing, especially in the elderly and renally impaired.
Vancomycin and Tobramycin (aminoglycoside) have overlapping nephrotoxicity and ototoxicity; co-administration potentiates renal and cochlear/vestibular injury, with added risk in renal impairment.
Monitor renal function, serum levels and ototoxicity signs during the combination.
Rising creatinine, oliguria, tinnitus or hearing loss require immediate reassessment.
Avoid the combination; if unavoidable, minimize duration and adjust doses to renal function.
DailyMed/FDA (NIH/NLM) — approved Tobramycin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c4751a4f-c9c1-60c5-e053-2995a90aeba9 ; approved Vancomycin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b01aaa02-8f1d-4b57-96a5-337503428af1 — with additional reference: Prontuário Terapêutico do INFARMED, INFARMED (11th ed., 2012)
Combining Gentamicin with Vancomycin significantly increases the risk of nephrotoxicity and ototoxicity, with an additive effect on the kidney and the eighth cranial nerve.
Vancomycin and aminoglycosides are nephro- and ototoxic through overlapping mechanisms (renal tubular accumulation and cochlear/vestibular damage). The vancomycin label states that "systemic vancomycin exposure may result in acute kidney injury (AKI)", and the gentamicin label that aminoglycosides "have an inherent potential for causing ototoxicity and nephrotoxicity", with "greater risk when administered for longer periods or in higher doses than recommended". The combination is frequent in endocarditis, sepsis and critically ill patients, and the risk adds up especially in the elderly, pre-existing renal impairment, hypovolaemia or prolonged therapy. Monitor creatinine and urine output daily, vancomycin and gentamicin levels (troughs/peaks), and ototoxicity signs (tinnitus, vertigo, hearing loss); adjust doses to creatinine clearance and consider extended intervals.
Vancomycin + gentamicin: additive nephro- and ototoxicity (tubular + cochlear/vestibular damage). Monitor renal function, levels and hearing.
Vancomycin and aminoglycosides are nephrotoxic and ototoxic; co-administration potentiates renal tubular and auditory injury, a well-documented risk particularly in critically ill patients or those with renal impairment.
Closely monitor renal function, vancomycin and gentamicin serum levels, urine output and signs of ototoxicity.
Rising creatinine, oliguria, tinnitus, vertigo or hearing loss require immediate reassessment of therapy.
Avoid when possible; if clinically necessary, minimize duration, ensure hydration and adjust doses to renal function.
DailyMed/FDA (NIH/NLM) — approved Gentamicin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=441b6232-bb60-40ad-85ec-7c41ba43fd5f ; approved Vancomycin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b01aaa02-8f1d-4b57-96a5-337503428af1 — with additional reference: Prontuário Terapêutico do INFARMED, INFARMED (11th ed., 2012)
Combining Amikacin with Vancomycin increases the risk of nephrotoxicity and ototoxicity, with an additive effect on the kidney and the inner ear.
Vancomycin ("systemic exposure may result in acute kidney injury") and amikacin (an aminoglycoside with "ototoxicity and nephrotoxicity associated with their use", ototoxicity being "usually irreversible" and "greater in patients with renal damage") have overlapping toxicity that adds up in combination. The risk is particularly high in critically ill patients, pre-existing renal impairment, hypovolaemia, sepsis or prolonged therapy, and nephrotoxicity "may not become apparent until the first few days after cessation of therapy" (amikacin label). Monitor creatinine daily, vancomycin and amikacin levels, and otological symptoms (tinnitus, vertigo, hearing loss); adjust doses to creatinine clearance and reassess the need to keep both after 5–7 days.
Vancomycin + amikacin: additive renal and cochlear/vestibular toxicity. Monitor renal function, levels and hearing; adjust to creatinine clearance.
Vancomycin and Amikacin (aminoglycoside) are nephrotoxic and ototoxic; combined use adds renal and cochlear/vestibular toxicity, particularly with prior renal impairment or prolonged therapy.
Monitor renal function, serum levels of both drugs and signs of ototoxicity.
Worsening renal function, oliguria or auditory signs require prompt discontinuation and evaluation.
Avoid the combination; if needed, use the shortest course, hydrate and adjust doses to renal function.
DailyMed/FDA (NIH/NLM) — approved Amikacin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f260ff2a-76a0-4672-9516-91c344b67890 ; approved Vancomycin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b01aaa02-8f1d-4b57-96a5-337503428af1 — with additional reference: Prontuário Terapêutico do INFARMED, INFARMED (11th ed., 2012)
Vancomycin is given intravenously (or orally for Clostridioides difficile colitis); food does not affect systemic pharmacokinetics.
May be administered regardless of meals.
DailyMed/FDA (NIH/NLM) — approved Vancomycin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b01aaa02-8f1d-4b57-96a5-337503428af1
No relevant pharmacokinetic interaction; usual moderation during treatment.
Moderate alcohol intake.
DailyMed/FDA (NIH/NLM) — approved Vancomycin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b01aaa02-8f1d-4b57-96a5-337503428af1
Vancomycin is eliminated renally; renal impairment increases the risk of nephrotoxicity and ototoxicity.
Monitor serum levels (troughs) and renal function; adjust dose and interval.
DailyMed/FDA (NIH/NLM) — approved Vancomycin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b01aaa02-8f1d-4b57-96a5-337503428af1
Vancomycin can cause ototoxicity; patients with pre-existing hearing loss are at increased risk.
Monitor for ototoxic symptoms in prolonged treatment or with high levels.
DailyMed/FDA (NIH/NLM) — approved Vancomycin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b01aaa02-8f1d-4b57-96a5-337503428af1
Data on vancomycin in pregnancy are limited; use only if the benefit outweighs the risk (e.g., severe Gram-positive infections).
Use only in severe infections with no safe alternative; monitor levels.
Present in breast milk in small amounts; generally compatible with breastfeeding.
No specific contraception required.
DailyMed/FDA (NIH/NLM) — approved Vancomycin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b01aaa02-8f1d-4b57-96a5-337503428af1
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
After oral administration, vancomycin acts locally in the gut lumen (bactericidal activity against C. difficile and S. aureus). Given IV it is time-dependent bactericidal, active against Gram-positives. Nephrotoxicity occurred in 5% of patients with C. difficile diarrhoea; ototoxicity reported mainly with IV use.
The bactericidal action against S. aureus and the vegetative cells of C. difficile results primarily from inhibition of cell-wall biosynthesis; it also alters bacterial membrane permeability and RNA synthesis.
Negligible oral absorption: after repeated oral doses, faecal concentrations exceed 100 mg/kg and no blood concentrations are detected (urinary recovery <0.76%). In patients with active C. difficile diarrhoea, measurable serum concentrations may occur; with renal impairment accumulation is possible. Given IV, it distributes widely (coefficient 0.3-0.43 L/kg); protein binding ~55%.
Virtually no metabolism. Given orally it is essentially unabsorbed, acting in the gut; given IV it is excreted by glomerular filtration (about 75% of the dose in 24 hours), with no apparent metabolism.
Orally the half-life is not measurable (no systemic absorption). Given IV, the elimination half-life is 4-6 hours in patients with normal renal function; in anephric patients the mean half-life is 7.5 days. Half-life correlates with creatinine clearance.
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
