Sterile Vancomycin Hydrochloride, USP, intravenous, is a chromatographically purified tricyclic glycopeptide antibiotic derived from Amycolatopsis orientalis (formerly Nocardia orientalis) and has the molecular formula C66H75Cl2N9O24• HCl.
Vancomycin hydrochloride is indicated for the treatment of serious or severe infections caused by susceptible strains of methicillin-resistant (β -lactam-resistant) staphylococci. It is indicated for penicillin-allergic patients, for patients who cannot receive or who have failed to respond to other drugs, including the penicillins or cephalosporins, and for infections caused by vancomycin-susceptible organisms that are resistant to other antimicrobial drugs. Vancomycin hydrochloride is indicated for initial therapy when methicillin-resistant staphylococci are suspected, but after susceptibility data are available, therapy should be adjusted accordingly.
Vancomycin hydrochloride is effective in the treatment of staphylococcal endocarditis. Its effectiveness has been documented in other infections due to staphylococci, including septicemia, bone infections, lower respiratory tract infections, skin and skin-structure infections. When staphylococcal infections are localized and purulent, antibiotics are used as adjuncts to appropriate surgical measures.
Vancomycin hydrochloride has been reported to be effective alone or in combination with an aminoglycoside for endocarditis caused by S. viridans or S. bovis. For endocarditis caused by enterococci (e.g., E. faecalis), vancomycin hydrochloride has been reported to be effective only in combination with an aminoglycoside.
Vancomycin hydrochloride has been reported to be effective for the treatment of diphtheroid endocarditis. Vancomycin hydrochloride has been used successfully in combination with either rifampin, an aminoglycoside, or both in early-onset prosthetic valve endocarditis caused by S. epidermidis or diphtheroids.
Specimens for bacteriologic cultures should be obtained in order to isolate and identify causative organisms and to determine their susceptibilities to vancomycin hydrochloride.
The parenteral form of vancomycin hydrochloride may be administered orally for treatment of antibiotic-associated pseudomembranous colitis produced by C. difficile and for staphylococcal enterocolitis. Parenteral administration of vancomycin hydrochloride alone is of unproven benefit for these indications. Vancomycin hydrochloride is not effective by the oral route for other types of infection.
Although no controlled clinical efficacy studies have been conducted, intravenous vancomycin has been suggested by the American Heart Association and the American Dental Association as prophylaxis against bacterial endocarditis in penicillin-allergic patients who have congenital heart disease or rheumatic or other acquired valvular heart disease when these patients undergo dental procedures or surgical procedures of the upper respiratory tract.
NOTE: When selecting antibiotics for the prevention of bacterial endocarditis, the physician or dentist should read the full joint statement of the American Heart Association and the American Dental Association.3
To reduce the development of drug-resistant bacteria and maintain the effectiveness of vancomycin and other antibacterial drugs, vancomycin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
Media Articles Related to Vancomycin
Vancomycin-Resistant Enterococci (VRE)
Source: MedicineNet ICU Psychosis Specialty [2011.02.23]
Title: Vancomycin-Resistant Enterococci (VRE)
Category: Diseases and Conditions
Created: 5/8/2007 12:00:00 AM
Last Editorial Review: 2/23/2011 12:00:00 AM
Zyvox® shows cost savings for treatment of skin infections
Source: The Doctors Lounge - Infections
Oral Zyvox® shows cost savings for outpatient treatment of skin and other infections when compared to vancomycin.
Published Studies Related to Vancomycin
Reduced acquisition and overgrowth of vancomycin-resistant enterococci and
Candida species in patients treated with fidaxomicin versus vancomycin for
Clostridium difficile infection. 
Fidaxomicin causes less disruption of anaerobic microbiota during treatment of
Clostridium difficile infection (CDI) than vancomycin and has activity against
many vancomycin-resistant enterococci (VRE). In conjunction with a multicenter
randomized trial of fidaxomicin versus vancomycin for CDI treatment, we tested
the hypothesis that fidaxomicin promotes VRE and Candida species colonization
less than vancomycin...
Meta-analysis of randomized controlled trials of vancomycin for the treatment of
patients with gram-positive infections: focus on the study design. 
of other antibiotics for the treatment of gram-positive infections... CONCLUSION: On the basis mainly of data from open-label trials, vancomycin is a
Efficacy and safety of tigecycline monotherapy compared with vancomycin-aztreonam in the treatment of complicated skin and skin structure infections in patients from India and Taiwan. [2011.04]
BACKGROUND: To compare the monotherapy of tigecycline with vancomycin-aztreonam in hospitalized patients from India and Taiwan with complicated skin and skin structure infections (cSSSIs)... CONCLUSIONS: Tigecycline monotherapy is a safe and effective therapy for cSSSIs in geographically distinct populations in Asia. Copyright (c) 2011. Published by Elsevier B.V.
Fidaxomicin versus vancomycin for Clostridium difficile infection. [2011.02.03]
BACKGROUND: Clostridium difficile infection is a serious diarrheal illness associated with substantial morbidity and mortality. Patients generally have a response to oral vancomycin or metronidazole; however, the rate of recurrence is high. This phase 3 clinical trial compared the efficacy and safety of fidaxomicin with those of vancomycin in treating C. difficile infection... CONCLUSIONS: The rates of clinical cure after treatment with fidaxomicin were noninferior to those after treatment with vancomycin. Fidaxomicin was associated with a significantly lower rate of recurrence of C. difficile infection associated with non-North American Pulsed Field type 1 strains. (Funded by Optimer Pharmaceuticals; ClinicalTrials.gov number, NCT00314951.)
Telavancin versus vancomycin for hospital-acquired pneumonia due to gram-positive pathogens. [2011.01.01]
BACKGROUND: Telavancin is a lipoglycopeptide bactericidal against gram-positive pathogens... CONCLUSIONS: The primary end point of the studies was met, indicating that telavancin is noninferior to vancomycin on the basis of clinical response in the treatment of HAP due to gram-positive pathogens.
Clinical Trials Related to Vancomycin
Trial of Prophylactic Versus Empirical Vancomycin for the Prevention of Streptococcal Sepsis After Hematopoietic Cell Transplantation [Completed]
This is a randomized 2-arm study to compare two different times of giving the drug
vancomycin. Half of the patients will begin vancomycin two days before a bone marrow
transplant. The other half will get it as soon as they have the first fever.
Streptococci are bacteria that live in one's mouth and gut. These bacteria can escape into
the blood when the lining of the mouth and gut weakens from cancer therapy. This can make
the person who is undergoing a bone marrow transplant very sick. All patients who get this
infection are treated with antibiotics. Vancomycin is one drug that is used to treat this
bloodstream infection once it is diagnosed. Studies have shown that giving vancomycin before
a bone marrow transplant seems to prevent this infection. However, giving vancomycin too
soon may increase the chance that the kidneys will be irritated. It may also increase the
chance that other bacteria will become resistant to this drug. We, the investigators at
Memorial Sloan-Kettering Cancer Center, do not know if waiting to start vancomycin until the
patient has a first fever can also prevent this infection.
Vancomycin Study: Treatment of Catheter Related Bloodstream Infection Caused by Coagulase Negative Staphylococcus [Completed]
Patients admitted into the Intensive Care Unit (ICU) have an intravenous (IV) catheter (small
plastic tube) placed in their vein. Very occasionally (4 times out of 100) the insertion of
an intravenous catheter may cause an infection in the blood. It has been shown that the
removal of the catheter and the insertion of a new one at a new site helps to get rid of this
infection. Sometimes, antibiotics are also given.
Vancomycin is the antibiotic given intravenously (into the vein) to treat these
catheter-related infections. At Vancouver General Hospital, some physicians may not give any
vancomycin at all whereas others may treat with intravenous (IV) vancomycin for one to
Since there are a lack of data to support the length of IV vancomycin therapy, the
investigators would like to find out if two days of IV vancomycin are as good as seven days.
Therefore, the purpose of this study is to determine if two days of IV vancomycin are as good
as seven days for the treatment of catheter-related infections in the blood.
Pharmacokinetics of Vancomycin in the ICU in Renal Replacement Therapy [Recruiting]
This study is an observational analysis that monitors the effect of different dialysis
methods on vancomycin levels when patients are critically ill. No changes are made to
therapy based on levels, but levels are checked more frequently than normal. The primary
dialysis methods being studied are SLED (slow-low efficiency daily) dialysis and
intermittent hemodialysis. Vancomycin is the only medication being evaluated in this study.
This study will provide detailed information on how to dose vancomycin in patients that are
on dialysis in the intensive care unit.
Evaluating the Use of Large-dose, Extended Interval Vancomycin Intravenous Administration for Skin and Soft Tissue Infections [Recruiting]
Intracolonic Vancomycin Therapy in Severe C. Diff Colitis [Recruiting]
Clostridium difficile is a bacteria that can infect the colon and cause severe diarrhea in
patients after recent antibiotic use. The current standard of care treatment for severe C.
diff. consists of oral vancomycin and/or intravenous metronidazole. When treatment is
unsuccessful, it can lead to need for removal of the entire colon or even death. In fact,
mortality rates in the literature range from 11-37% for C. diff. The most commonly quoted
mortality rate is 14% for severe infection. It is believed that the failure of treatment
may stem from an adynamic ileus (paralysis of the small bowel). This ileus may prevent the
oral vancomycin from reaching the colon and therefore it does not treat the problem.
Vancomycin functions by direct contact with the colon. Therefore, if the vancomycin is
instilled directly into the colon, it can come into contact with and be its intended target.
: The objective of the study is to improve treatment of severe C. diff. colitis . C.
diff. infection is defined as severe if there is evidence of ileus accompanied by any one of
the following: fever greater than 38. 30C, , acidemia, serum albumin less than 2. 5, or white
blood cell count greater than 14,000.
Reports of Suspected Vancomycin Side Effects
Drug Rash With Eosinophilia and Systemic Symptoms (104),
Renal Failure Acute (100),
Renal Failure (45),
Septic Shock (35),
Toxic Epidermal Necrolysis (34),
Stevens-Johnson Syndrome (31),
Renal Impairment (28), more >>
Page last updated: 2013-02-10