What is vancomycin injection?

Vancomycin injection is an antibiotic used to treat serious bacterial infections. It works by stopping the growth of bacteria. 

Vancomycin is usually injected into a vein. However, this product also comes in vials which may also be given by mouth to treat a severe intestinal condition known as Clostridium difficile-associated diarrhea. This condition can rarely occur after the use of antibiotics has allowed the growth of a certain kind of resistant bacteria in the intestines, leading to severe diarrhea

When vancomycin is given by mouth, it is not absorbed by the body but remains in the intestines, allowing it to stop the growth of the bacteria. 

Common side effects of vancomycin injection include:

  • pain,
  • redness, and
  • tenderness at the injection site. 

Serious side effects of vancomycin injection include:

Use of vancomycin injection for prolonged or repeated periods may result in:

If vancomycin injection is injected too fast, a condition known as “red man syndrome” may occur (symptoms include flushing of the upper body, dizziness, low blood pressure, or muscle pain/spasms of the chest and back). 

Drug interactions of vancomycin injection include: 

  • cidofovir,
  • drugs that may harm the kidneys (amphotericin B, cisplatin, polymyxin, colistin, aminoglycosides such as gentamicin, tobramycin),
  • other antibiotics, and
  • live bacterial vaccines

Although most antibiotics probably do not affect hormonal birth control such as pills, patch, or ring, some antibiotics may decrease their effectiveness. This could cause pregnancy

During pregnancy, vancomycin injection should be used only when clearly needed. Discuss the risks and benefits with your doctor. 

Vancomycin injection passes into breast milk. Consult your doctor before breastfeeding.

What are the important side effects of vancomycin?

The most common side effects associated with oral vancomycin treatment are

Less common side effects are:

Rare but serious side effects are

vancomycin side effects list for healthcare professionals

Infusion-Related Events

During or soon after rapid infusion of vancomycin, patients may develop anaphylactoid reactions, including hypotension, wheezing, dyspnea, urticaria, or pruritus. Rapid infusion may also cause flushing of the upper body (“red neck”) or pain and muscle spasm of the chest and back.

These reactions usually resolve within 20 minutes but may persist for several hours. Such events are infrequent if vancomycin is given by a slow infusion over 60 minutes. In studies of normal volunteers, infusion-related events did not occur when vancomycin was administered at a rate of 10 mg/min or less.

Nephrotoxicity

Renal failure, principally manifested by increased serum creatinine or BUN concentrations, especially in patients administered large doses of vancomycin, has been reported rarely. Cases of interstitial nephritis have also been reported rarely. Most of these have occurred in patients who were given aminoglycosides concomitantly or who had preexisting kidney dysfunction. When vancomycin was discontinued, azotemia resolved in most patients.

Gastrointestinal

Onset of pseudomembranous colitis symptoms may occur during or after antibiotic treatment.

Ototoxicity

A few dozen cases of hearing loss associated with vancomycin have been reported. Most of these patients had kidney dysfunction or a preexisting hearing loss or were receiving concomitant treatment with an ototoxic drug. Vertigo, dizziness, and tinnitus have been reported rarely.

Hematopoietic

Reversible neutropenia, usually starting 1 week or more after onset of therapy with vancomycin or after a total dosage of more than 25 g, has been reported for several dozen patients. Neutropenia appears to be promptly reversible when vancomycin is discontinued. Thrombocytopenia has rarely been reported. Although a causal relationship has not been established, reversible agranulocytosis (granulocytes <500/mm3) has been reported rarely.

Phlebitis

Inflammation at the injection site has been reported.

Miscellaneous

Infrequently, patients have been reported to have had anaphylaxis, drug fever, nausea, chills, eosinophilia, rashes including exfoliative dermatitis, Stevens-Johnson syndrome, and vasculitis in association with administration of vancomycin.

Chemical peritonitis has been reported following intraperitoneal administration of vancomycin.

Post Marketing Reports

The following adverse reactions have been identified during post-approval use of vancomycin. Because these reactions are reported voluntarily from a population of uncertain size, it is not possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Skin And Subcutaneous Tissue Disorders

Drug Rash with Eosinophilia and Systemic Symptoms (DRESS)

What drugs interact with vancomycin?

Concomitant administration of vancomycin and anesthetic agents has been associated with erythema and histamine-like flushing and anaphylactoid reactions.

Concurrent and/or sequential systemic or topical use of other potentially neurotoxic and/or nephrotoxic drugs, such as amphotericin B, aminoglycosides, bacitracin, polymyxin B, colistin, viomycin, or cisplatin, when indicated, requires careful monitoring.

Treatment & Diagnosis

Medications & Supplements

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Medically Reviewed on 4/30/2020
References
FDA Prescribing Information

Professional side effects and drug interactions sections courtesy of the U.S. Food and Drug Administration.