Vanomycin tablet
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vancomycin oral tablet formulation uses dosage
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Here is a comprehensive overview of Vancomycin (commonly misspelled "Vanomycin"):
Vancomycin - Complete Drug Profile
What It Is
Vancomycin is a glycopeptide antibiotic produced by Streptomyces orientalis. It inhibits early stages of cell wall peptidoglycan synthesis, making it bactericidal against most Gram-positive organisms.
Spectrum of Activity (Gram-positive organisms only)
- Staphylococcus aureus including MRSA and coagulase-negative staphylococci
- Streptococcus species including S. pneumoniae
- Enterococcus species
- Bacillus, Corynebacterium jeikeium
- Gram-positive anaerobes: Peptostreptococcus, Actinomyces, Clostridium, Propionibacterium
- NOT active against Gram-negative organisms
(Harrison's Principles of Internal Medicine 22E)
Formulations - KEY POINT
| Formulation | Route | Purpose |
|---|---|---|
| IV solution | Intravenous | Systemic infections (MRSA sepsis, endocarditis, pneumonia, osteomyelitis) |
| Oral capsules / solution | Oral (PO) | C. difficile infection & S. aureus enterocolitis ONLY |
There is no vancomycin "tablet." The oral form comes as capsules (Vancocin) or the IV powder dissolved in water/juice. Oral vancomycin is poorly absorbed from the gut - this is actually why it works for C. difficile: it stays in the colon at very high concentrations without causing systemic toxicity.
Clinical Uses
IV Vancomycin (systemic):
- MRSA infections: bacteremia, endocarditis, pneumonia, osteomyelitis, skin/soft tissue infections
- Alternative for MSSA when patient cannot tolerate beta-lactams
- Empiric coverage in suspected Gram-positive sepsis
- CNS shunt infections
Oral Vancomycin (gut-limited):
- First-line treatment for Clostridioides difficile infection (CDI)
- Standard dose: 125 mg every 6 hours x 10 days (as effective as 500 mg QID)
- Severe/fulminant CDI: 500 mg QID
- Staphylococcus aureus enterocolitis
(Sleisenger & Fordtran's GI and Liver Disease; Jawetz Medical Microbiology 28E)
Note: IV vancomycin does NOT work for CDI - effective colonic concentrations are not achieved parenterally.
Pharmacokinetics
- Oral: Poorly/not absorbed systemically - stays in gut lumen (ideal for CDI)
- IV: Widely distributed in tissues; excreted renally - requires dose adjustment in renal impairment
- PK/PD target: AUC/MIC ratio >400 is the best predictor of efficacy (concentration-dependent killing)
- Trough target for MRSA: 15-20 mcg/mL
Adverse Effects
| Effect | Details |
|---|---|
| Nephrotoxicity | Most important; risk increases with trough >20 mcg/mL; worsened by aminoglycosides |
| Red Man Syndrome (Vancomycin Infusion Reaction) | Histamine-mediated erythematous rash on face/neck/trunk from rapid infusion; treat with diphenhydramine + slow infusion |
| Ototoxicity | Rare with modern purified formulations; was more common historically |
| Thrombophlebitis | At IV site |
| Leukopenia | Uncommon |
(Harrison's 22E; Jawetz Medical Microbiology 28E)
Resistance Concerns
- VISA (Vancomycin-Intermediate S. aureus): MIC 4-8 mcg/mL
- VRSA (Vancomycin-Resistant S. aureus): via acquisition of vanA genes from VRE
- VRE (Vancomycin-Resistant Enterococci): major problem; VanA type also resistant to teicoplanin; VanB type remains susceptible to teicoplanin
- For enterococcal sepsis/endocarditis, vancomycin must be combined with an aminoglycoside
Monitoring
- Renal function (serum creatinine) regularly
- Vancomycin serum levels (trough or AUC monitoring)
- Auditory function if prolonged use
Important Practical Note
The IV powder for injection can be dissolved in water and given orally for CDI at a much lower cost than branded Vancocin capsules - this is a commonly used cost-saving strategy in clinical practice. (Sleisenger & Fordtran)
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