Vancomycin is a glycopeptide commonly used to treat MRSA.
Indications for Use: Vancomycin is a popular glycopeptide that is active against gram-positive bacteria. Vancomycin is commonly used to treat serious or severe infections when other antibiotics are ineffective or contraindicated, including those caused by MRSA.
Mechanism of Action: Glycopeptides are a class of medications that inhibit bacterial cell wall synthesis.
Special Administration Considerations: It is poorly absorbed from the GI tract, so it must be given by IV to treat a systemic infection. Oral vancomycin, on the other hand, is used to treat antibiotic-associated clostridium difficile (C-diff). Vancomycin poses a significant risk to kidney function and hearing; therefore, clients’ trough levels must be monitored carefully for effective IV dosing to avoid complications. Clients receiving IV vancomycin may also experience a complication known as “red man syndrome” in which they experience a flushing of the skin and a reddish rash on the upper body when the infusion is administered too rapidly.
Client Teaching/Education: Clients should be counselled to take medications as directed for the full course of antibacterial therapy. They should monitor for side effects such as hypersensitivity, tinnitus, hearing loss, and vertigo. Clients should promptly follow up with their healthcare provider if no improvement in symptoms is identified.[1][2]
Vancomycin Medication Card
Now let’s take a closer look at the medication card on vancomycin.[3] Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication.
Medication Card 3.21.1: Miscellaneous Antibacterials: Glycopeptides (Vancomycin)
Class: Miscellaneous Antibacterials: Glycopeptides
Prototypes: Vancomycin
Therapeutic Effects
- Monitor for systemic signs of infection:
- WBC
- Temperature
- Culture results
- Monitor site of infection for improvement
- Monitor and report trough levels for targeted dosing
Administration
- IV only (except for C. diff, PO)
- SE can be minimized if infusion rate is slowed
- Dosage adjustment is required for renal impairment
- Monitor trough levels
- IV should be administered in a diluted solution over a period of 60 minutes or more to avoid rapid-infusion-related reactions
Indications
- Generally only used for serious staphylococcal infections
- Effective against Gram +
- MRSA
- VRE
- C-diff
- Bone infection
- Blood infection
Side Effects
- Nausea
- Ototoxicity
- Nephrotoxicity
- Neutropenia
- Blood disorders
- “Red man syndrome” [not harmful] Flushing, redness, itchiness upper trunk, face, head, neck
Nursing Considerations
- Contraindicated in:
- o Neuromuscular blockers
- o Hearing problem
- o Kidney dysfxn
- o Neonates
- o Geriatrics
- maintain hydration
- monitor urine output
- v low dose = no effect, high = toxic
Using the above information, consider the following clinical scenario question:
A nurse is caring for a client who was prescribed vancomycin IV for a MRSA infection. The dose of medication is due now, but a trough level is not yet available in the chart. What is the nurse’s next best response?
Note: Answers to the activities can be found in the “Answer Key” sections at the end of the book.
- uCentral from Unbound Medicine. https://www.unboundmedicine.com/ucentral ↵
- UpToDate (2021). Vancomycin. https://www.uptodate.com/contents/search ↵
- Daily Med, https://dailymed.nlm.nih.gov/dailymed/index.cfm, used for hyperlinked medications in this module. Retrieved June 27, 2019 ↵