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Glycopeptide antibiotic

Vancomycin

Brand names: Vancocin

Used in: Cellulitis & Skin Infection

Vancomycin is a glycopeptide antibiotic used intravenously for serious Gram-positive infections (including MRSA), and orally (where it is not absorbed) for Clostridioides difficile infection.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

DOSAGE AND ADMINISTRATION Infusion-related events are related to both the concentration and the rate of administration of vancomycin. Concentrations of no more than 5 mg/mL and rates of no more than 10 mg/min, are recommended in adults (see also age-specific recommendations). In selected patients in need of fluid restriction, a concentration up to 10 mg/mL may be used; use of such higher concentrations may increase the risk of infusion-related events. An infusion rate of 10 mg/min or less is associated with fewer infusion-related events (see ADVERSE REACTIONS ). Infusion-related events may occur, however, at any rate or concentration. Patients with Normal Renal Function Adults The usual …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2026-01-30. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Clinical monograph

How it works

It inhibits bacterial cell-wall synthesis by binding peptidoglycan precursors; given orally it acts locally in the gut because it is not absorbed.

Prescribing in practice

  • Intravenous dosing is guided by levels (trough or AUC) and renal function — it is nephrotoxic and ototoxic, especially with other such drugs.
  • Rapid intravenous infusion causes the 'red man' (vancomycin infusion) reaction — infuse slowly.
  • Oral vancomycin treats gut infection (C. difficile) only and does not treat systemic infection.

Monitoring

Monitor vancomycin levels and renal function during intravenous therapy; consider hearing where prolonged or with other ototoxic drugs.

Counselling the patient

  • The intravenous form is given slowly to avoid flushing or rash.
  • For C. difficile, the oral form works in the gut — complete the course.
  • Attend blood tests to check levels and kidney function.

Evidence & guidelines

A mainstay for serious Gram-positive/MRSA infection (intravenous, level-guided) and a first-line oral treatment for C. difficile infection (NICE NG199).

Reference: ASHP/IDSA/SIDP 2020 Vancomycin Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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