Vancomycin
Vancomycin hydrochloride
is used increasingly to
treat methi-cillin-resistant S. aureus,
which has become a major concern in the United States and other parts of the
world. Because of the emergence of vancomycin-resistant enterococci, vancomycin
must be used judiciously. As a rule of thumb, it should be used only when
culture and sensitivity test results confirm the need for it.
Because vancomycin is absorbed poorly from
the GI tract, it must be given I.V. to treat systemic infections. However, an
oral form of vancomycin is used to treat pseudomembranous colitis. Van-comycin
diffuses well into pleural (around the lungs), pericardial (around the heart),
synovial (joint), and ascitic (in the peritoneal cavity) fluids.
Remember that I.V. vancomycin can’t be used in
place of oral van-comycin and vice versa. The two forms aren’t interchangeable.
The metabolism of vancomycin is unknown. About 85%
of the dose is excreted unchanged in urine within 24 hours. A small amount may
be eliminated through the liver and biliary tract.
Vancomycin inhibits bacterial cell-wall synthesis,
damaging the bacterial plasma membrane. When the bacterial cell wall is
damaged, the body’s natural defenses can attack the organism.
Vancomycin is active against gram-positive
organisms, such as S. aureus, S.
epidermidis, S. pyogenes, Enterococcus, and S. pneumoniae.
I.V. vancomycin is the therapy of choice for the
patient with a seri-ous resistant staphylococcal infection who’s hypersensitive
to penicillins.
Oral vancomycin is used for the patient with
antibiotic-associated Clostridium
difficile colitis who can’t take or has respondedpoorly to metronidazole.
Vancomycin, when used with an aminoglycoside, is
also the treat-ment of choice for E.
faecalis endocarditis in the patient who’s al-lergic to penicillin.
Vancomycin may increase the risk of toxicity
when administered with other drugs toxic to the kidneys and organs of hearing,
such as aminoglycosides, amphotericin B, bacitracin, cisplatin, colistin, and
polymyxin B. (See Adverse reactions to
vancomycin.)
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