44 Questions
What is the peak concentration range associated with ototoxicity?
Greater than 50 mg/L
What is the limited postantibiotic effect duration of the medication?
0.5 to 3 hours
Who are the patients requiring monitoring due to high clearances and short half lives?
Pediatric patients
What is a common side effect of the medication?
Phlebitis
How should the medication be infused to minimize histamine response?
Over 60 minutes
What is the incidence of nephrotoxicity when the medication is used as a single agent?
<5%
What is the bioavailability after oral administration?
Poorly absorbed after oral administration
What is the primary spectrum of activity of Vancomycin?
Gram-positive
What is the recommended route of administration for systemic infections?
Intravenous
What is the ideal peak plasma concentration range for Vancomycin?
Less than 40 to 50 mg/L
What is the primary reason for the resurgence in the use of Vancomycin?
Increased prevalence of Nafcillin-resistant Staphylococcus
What is the recommended peak concentration range for Vancomycin to minimize the risk of ototoxicity?
5 to 15 mg/L
What is the maximum concentration associated with ototoxicity?
50 mg/L
What is the maximum MIC for sensitive bacteria?
< 5 mg/L
What is the duration of limited postantibiotic effect of Vancomycin?
0.5 to 3 hours
What is the recommended infusion duration to minimize histamine response?
Over 60 min
What is the bioavailability of Vancomycin after oral administration?
Poorly absorbed
What are the patients requiring monitoring due to high clearances and short half lives?
Pediatric patients
What is the recommended dosing for Vancomycin in patients with normal renal function?
1g administered intravenously over 60 minutes every 12 hours
What is the bioavailability of Vancomycin after oral administration?
Poorly absorbed orally
What is the primary spectrum of activity of Vancomycin?
Gram-positive organisms, except against enterococci
What is the ideal peak plasma concentration range for Vancomycin?
Less than 40 to 50 mg/L
What is a common side effect of Vancomycin?
Nephrotoxicity
What is a common side effect of Vancomycin?
Phlebitis
What are the patients requiring monitoring due to high clearances and short half lives?
Elderly and patients with diminished renal function
What is a common adverse effect associated with intramuscular administration of Vancomycin?
Painful injection site and local irritation
What is the primary reason for monitoring both peak and trough concentrations of Vancomycin in overweight or underweight patients?
Wide fluctuation in concentration
What is the maximum incidence of nephrotoxicity when Vancomycin is used as a single agent?
Low incidence
What is the recommended time to obtain peak plasma concentrations if peak levels are to be measured?
1 or 2 hours after the end of infusion period
What is the recommended dosing interval for Vancomycin based on its half-life?
Approximately one half-life
What is the primary risk associated with poor renal function in patients receiving Vancomycin?
Greater risk of toxicity and inflammation
What kind of model does Vancomycin follow, making it difficult to avoid distribution phase when measuring peak levels?
Multicompartment model
What is the recommended range for steady state trough concentrations of Vancomycin?
5 to 15 mg/L
What is the recommended range for steady state trough concentrations of Vancomycin?
10 to 15 mg/L
What combination is used to treat Clostridium difficile?
Oral Vancomycin and Metronidazole
What describes distribution of Vancomycin?
Two or three compartment model best describes distribution
Vancomycin is eliminated primarily by:
Renal route
How much percentage of vancomycin dose is metabolized in the liver?
5%
What should be done with those patients having hemo or peritoneal dialysis vancomycin loss?
Both A & B
What is the half life of Vancomycin?
5 to 10 hours
Patients with normal renal function receives vancomycin every:
8 to 12 hours
In patients with end stage renal disease half life of vancomycin may approach:
10 days
End stage renal disease receive dose of vancomycin:
Once a week
What advantage can be gained from limited oral availability of Vancomycin?
Treating enterocolitis
Study Notes
Vancomycin Pharmacology and Administration
- Peak concentration range associated with ototoxicity: 50-60 mg/L
- Limited postantibiotic effect duration: 1-2 hours
- Patients requiring monitoring due to high clearances and short half-lives: Neonates, infants, and patients with cystic fibrosis
- Common side effect: Nephrotoxicity
- Medication infusion to minimize histamine response: Infuse over 60 minutes
- Incidence of nephrotoxicity when used as a single agent: 5-15%
- Bioavailability after oral administration: Virtually 0% (not absorbed orally)
Spectrum of Activity and Administration
- Primary spectrum of activity: Gram-positive bacteria
- Recommended route of administration for systemic infections: Intravenous
- Ideal peak plasma concentration range: 15-20 mg/L
- Primary reason for the resurgence in the use of Vancomycin: Increased methicillin-resistant Staphylococcus aureus (MRSA) infections
Pharmacokinetics and Adverse Effects
- Recommended peak concentration range to minimize ototoxicity risk: 15-20 mg/L
- Maximum concentration associated with ototoxicity: 80-100 mg/L
- Maximum MIC for sensitive bacteria: 1-2 mcg/mL
- Duration of limited postantibiotic effect: 1-2 hours
- Recommended infusion duration to minimize histamine response: 60 minutes
- Bioavailability after oral administration: Virtually 0% (not absorbed orally)
- Patients requiring monitoring due to high clearances and short half-lives: Neonates, infants, and patients with cystic fibrosis
Dosing and Monitoring
- Recommended dosing for Vancomycin in patients with normal renal function: 30-60 minutes
- Bioavailability after oral administration: Virtually 0% (not absorbed orally)
- Primary spectrum of activity: Gram-positive bacteria
- Ideal peak plasma concentration range: 15-20 mg/L
- Common side effect: Nephrotoxicity
- Patients requiring monitoring due to high clearances and short half-lives: Neonates, infants, and patients with cystic fibrosis
- Common adverse effect associated with intramuscular administration: Pain and inflammation
Special Considerations
- Primary reason for monitoring both peak and trough concentrations of Vancomycin in overweight or underweight patients: To adjust dosing based on body weight
- Maximum incidence of nephrotoxicity when Vancomycin is used as a single agent: 15%
- Recommended time to obtain peak plasma concentrations if peak levels are to be measured: 1-2 hours after infusion
- Recommended dosing interval for Vancomycin based on its half-life: Every 8-12 hours
- Primary risk associated with poor renal function in patients receiving Vancomycin: Nephrotoxicity
- Model describing Vancomycin distribution: Multi-compartmental model
- Recommended range for steady-state trough concentrations of Vancomycin: 10-15 mg/L
- Combination used to treat Clostridium difficile: Vancomycin + metronidazole
- Description of Vancomycin distribution: Complex, multi-compartmental
- Elimination route: Primarily renal excretion
- Percentage of Vancomycin dose metabolized in the liver: <10%
- Recommendation for patients with hemo or peritoneal dialysis Vancomycin loss: Supplemental dose after dialysis
- Half-life of Vancomycin: 4-6 hours
- Dosing interval for patients with normal renal function: Every 8-12 hours
- Half-life of Vancomycin in patients with end-stage renal disease: Up to 200 hours
- Dosing recommendation for patients with end-stage renal disease: Individualized based on creatinine clearance
- Advantage gained from limited oral availability of Vancomycin: Reduced systemic absorption and side effects
Test your knowledge on the pharmacokinetics of Vancomycin, including therapeutic and toxic plasma concentrations, bioavailability, volume of distribution, half-life, clearance, sampling time, and side effects.
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