Vancomycin
Vancomycin: instructions for use and reviews
- 1. Release form and composition
- 2. Pharmacological properties
- 3. Indications for use
- 4. Contraindications
- 5. Method of application and dosage
- 6. Side effects
- 7. Overdose
- 8. Special instructions
- 9. Application during pregnancy and lactation
- 10. In case of impaired renal function
- 11. Drug interactions
- 12. Analogs
- 13. Terms and conditions of storage
- 14. Terms of dispensing from pharmacies
- 15. Reviews
- 16. Price in pharmacies
Latin name: Vancomycin
ATX code: J01XA01
Active ingredient: vancomycin (vancomycin)
Producer: Teva Pharmaceutical Industries (Israel), Kraspharma (Russia), MAKIZ-PHARMA (Russia), JODAS EXPOIM (India)
Description and photo update: 2019-13-08
Prices in pharmacies: from 159 rubles.
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Vancomycin is an antibiotic of the glycopeptide group.
Release form and composition
The drug is produced in the form of a powder (lyophilisate) for the preparation of a solution for infusion (0.5 g or 1 g each in glass bottles, 1 bottle in a cardboard box).
The active substance is vancomycin (in the form of hydrochloride).
Pharmacological properties
Pharmacodynamics
Vancomycin is a tricyclic glycopeptide antibiotic isolated from Amycolatopsis orientalis. This substance inhibits the biosynthesis of the cell wall of microorganisms (bactericidal effect), affects the permeability of the cell membrane and alters the synthesis of RNA. There is no cross-resistance between antibiotics of other classes and vancomycin.
Vancomycin in vitro is active against gram-positive microorganisms (Staphylococcus aureus, Staphylococcus epidermidis, including heterogeneous methicillin-resistant strains), Streptococcus pneumoniae (including penicillin-resistant strains), Streptococcus spp. viridans groups, Streptococcus agalactiae, Streptococcus bovis, enterococci (for example, Enterococcus faecalis and Clostridium difficile, including toxigenic strains) and Corynebacterium spp. Listeria monocytogenes and microorganisms of the genus Actinomyces, Lactobacillus, Bacillus and Clostridium are also susceptible to vancomycin in vitro.
There is evidence that some isolated strains of staphylococci and enterococci in vitro show resistance to this substance.
The in vitro combination of aminoglycosides and vancomycin is synergistic with many strains of Streptococcus spp. (except for enterogroup D), Staphylococcus aureus, Streptococcus spp. groups viridans and Enterococcus spp.
In vitro Vancomycin is inactive against viruses, gram-negative microorganisms, mycobacteria, fungi and protozoa.
When administered orally, it does not have a systemic effect and locally affects the sensitive microflora of the gastrointestinal tract (Clostridium difficile, Staphylococcus aureus).
Pharmacokinetics
After oral administration, vancomycin is absorbed in a minimal amount. The absorption of the drug is slightly increased in case of inflammation of the intestinal mucosa. After taking 500 mg of the drug every 6 hours, the maximum concentration of the active substance in the blood plasma with inflammation of the intestinal mucosa varies from 2.4 to 3 mg / l.
After intravenous administration of 500 mg of vancomycin in patients with normal renal function, the maximum concentration of the active substance in the blood plasma is 33 mg / l and is observed immediately after administration of the drug. 1 hour after administration, this figure is about 7.3 mg / l.
As a result of intravenous administration of 1000 mg of vancomycin, its concentration in blood plasma doubles. Immediately after infusion, this figure ranges from 20 to 50 mg / l, after 12 hours - from 5 to 10 mg / l.
After intravenous administration of 500 mg of Vancomycin for 1 hour, its average plasma concentration at the end of the infusion was approximately 33 mg / L, after 1 hour - 7.3 mg / L, and after 4 hours - 5.7 mg / L.
With repeated administration of Vancomycin, its concentration in blood plasma is similar to that in cases of a single administration.
The volume of distribution is 0.2-1.25 l / kg.
In children, including newborns, the volume of distribution is slightly less than in adults - from 0.53 to 0.82 l / kg. The results of ultrafiltration show that at a concentration of 10–100 mg / l of vancomycin in blood serum, its binding to plasma proteins is from 30 to 55%. After intravenous administration, vancomycin is found in various tissues of the body (liver, kidneys, heart, walls of abscesses, walls of blood vessels, lungs, tissue of the atrial appendage), body fluids (pericardial, pleural, peritoneal, ascitic, synovial) and in urine (in a concentration that inhibits growth of sensitive microorganisms). Slow penetration of vancomycin into the cerebrospinal fluid was recorded, however, in the case of inflammation of the meninges, a directly proportional increase in the rate of penetration of the drug through the blood-brain barrier is observed. The drug passes through the placental barrier and is excreted in breast milk.
Vancomycin is practically not metabolized. With normal renal function, the average plasma half-life is 4–6 hours. Approximately 75% of the vancomycin dose in the first 24 hours is excreted by the kidneys through the mechanism of glomerular filtration. With bile, it can be excreted in small quantities. With peritoneal dialysis or hemodialysis, it is excreted in small quantities. The average plasma clearance is approximately 0.058 L / kg / h, the average renal clearance is 0.048 L / kg / h. As a result of a fairly constant renal clearance, the excretion of vancomycin is 70–80%.
With impaired renal function, the excretion of vancomycin slows down. With anuria, the average elimination half-life is 7.5 days. Due to the naturally slowed glomerular filtration rate in elderly patients, the total renal and systemic clearance of vancomycin may decrease.
Indications for use
According to the instructions, Vancomycin is prescribed for the treatment of severe infectious and inflammatory diseases caused by pathogens sensitive to the active substance (with ineffectiveness or intolerance to treatment with other antibiotics, including cephalosporins or penicillins), such as:
- Sepsis;
- Infections of bones, joints, soft tissues and skin;
- Lung abscess;
- Pneumonia;
- Endocarditis (as monotherapy or concurrently with other antibiotic drugs);
- Meningitis;
- Pseudomembranous colitis caused by Clostridium difficile.
Contraindications
- Acoustic neuritis;
- Severe renal dysfunction;
- Lactation period and I trimester of pregnancy;
- Hypersensitivity to drug components.
The use in the first trimester of pregnancy is contraindicated, which is associated with the risk of developing oto- and nephrotoxicity. In the II-III trimesters, the use of the drug is possible only for health reasons.
It is recommended to stop breastfeeding during the therapy during lactation.
Instructions for the use of Vancomycin: method and dosage
Vancomycin is administered intravenously:
- Adults - 500 mg every 6 hours or 1000 mg every 12 hours;
- Children - 40 mg / kg per day.
To avoid collaptoid reactions, the duration of the infusion should be at least 1 hour.
In patients with impaired renal excretory function, the dosage is reduced taking into account the CC values.
The maximum daily adult dose is 3000-4000 mg.
Side effects
- Cardiovascular system: shock, hot flashes, cardiac arrest, decreased blood pressure (mainly these symptoms are associated with rapid infusion of the drug);
- Digestive system: nausea;
- Hematopoietic system: thrombocytopenia, eosinophilia, neutropenia, agranulocytosis;
- Senses: ringing in the ears, vertigo, ototoxic effects;
- Urinary system: changes in renal function tests, interstitial nephritis, impaired renal function;
- Allergic reactions: Stevens-Johnson syndrome, urticaria, vasculitis, toxic epidermal necrolysis. Anaphylactoid reactions are possible immediately in the process, or shortly after, too rapid infusion;
- Dermatological reactions: itchy dermatosis, exfoliative dermatitis, rash, benign blistering dermatosis;
- Others: drug fever, chills, pain and tissue necrosis at the injection sites, thrombophlebitis. With rapid intravenous administration, it is possible to develop "red neck syndrome" caused by the release of histamine: fainting, skin rash, erythema, redness of the hands, face, upper half of the body, neck, fever, heart palpitations, vomiting, chills.
Overdose
Symptoms: increased severity of dose-dependent side effects.
Treatment: symptomatic therapy to maintain glomerular filtration. With dialysis, vancomycin is poorly removed. There is evidence of an increase in the clearance of vancomycin as a result of hemoperfusion and hemofiltration using a polysulfone ion exchange resin.
special instructions
The drug should be used with caution in the II-III trimesters of pregnancy, with moderate and mild renal impairment, hearing impairment (including in history). During the period of therapy, patients with kidney disease and / or damage to the VIII pair of FMN should be monitored for hearing and renal function.
Intramuscular administration of vancomycin is not allowed, which is associated with a high risk of tissue necrosis.
When using the drug in elderly patients or newborns, the concentration of the active substance in the blood plasma should be monitored.
Application during pregnancy and lactation
The use of Vancomycin during pregnancy is allowed only in cases where the intended benefit to the mother is greater than the potential harm to the fetus.
The use of the drug during breastfeeding is contraindicated.
With impaired renal function
In case of renal failure, the drug should be used with caution. An individual dose adjustment is required.
Drug interactions
The simultaneous use of local anesthetics and vancomycin can lead to the development of histamine-like hot flashes, erythema and anaphylactic shock.
When combined with cisplatin, aminoglycosides, furosemide, amphotericin B, polymyxins and cyclosporin, an increase in nephro- and ototoxic action is noted.
Analogs
Vancomycin analogs are: Vancomycin J, Vancomycin-Teva, Vero-Vancomycin, Vanko, Vankorus, Vancomabol, Vankocin, Vankolon, Vankogen, Vankum, Vankomek, Lykovanum, Tankofeto, Editsin.
Terms and conditions of storage
Store in a dark place, out of reach of children, at temperatures up to 25 ° C.
Shelf life is 2 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Vancomycin
Reviews of Vancomycin indicate that this drug is a strong antibiotic, so it should only be used under medical supervision. Also, many reviews contain information about the development of serious side effects, such as decreased blood pressure, difficulty breathing, redness of the skin, the appearance of a feeling of heartbeat, and pain in the ears.
Vancomycin price in pharmacies
The approximate price for Vancomycin in the form of a lyophilisate for the preparation of a solution for infusion is: 1 g bottle - 225 rubles, 0.5 g bottle - 160 rubles.
Vancomycin: prices in online pharmacies
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Drug name Price Pharmacy |
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Vancomycin 500 mg powder for solution for infusion 1 pc. 159 r Buy |
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Vancomycin Elfa 1000 mg lyophilisate for preparation of solution for infusion 20 ml 1 pc. 239 r Buy |
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Vancomycin 1 g powder for solution for infusion 1 pc. 257 r Buy |
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Vancomycin powder for prig solution for inf. 1g 276 r Buy |
Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
