Glycopeptide antibiotic Pregnancy: Give in pregnancy only if clearly needed; monitor blood levels carefully to minimise foetal toxicity (significantly increased doses may be required). Excreted in human milk - caution in nursing women.

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.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 15-20 mg/kg

Route: Intravenous infusion

Frequency: Every 8 to 12 hours (patients aged 12 years and older)

Max: 2 g per dose

IV: initial dose based on total body weight; subsequent doses adjusted to serum trough concentrations and renal function. Seriously ill patients: a loading dose of 25-30 mg/kg may be used for rapid attainment of target trough. Peri-operative prophylaxis of bacterial endocarditis (all ages): initial 15 mg/kg prior to induction of anaesthesia; a second dose may be required depending on duration of surgery. Infuse slowly in a dilute solution (2.5-5.0 mg/mL) at a rate no greater than 10 mg/min over not less than 60 minutes to avoid infusion-related reactions. Must not be given intramuscularly. Duration is tailored to type/severity of infection (e.g. 7-14 days for complicated non-necrotizing skin/soft tissue infection; 4-6 weeks for infective endocarditis and bone/joint infections). Where appropriate, use in combination with other antibacterials. Oral administration (patients aged 12 and older) is also described but the source posology text was truncated. Elderly: lower maintenance doses may be required due to reduced renal function.

Paediatric dose

Route: Intravenous infusion

Frequency: Every 6 hours (infants and children from 1 month to less than 12 years)

Infants and children 1 month to <12 years: 10-15 mg/kg every 6 hours (range stated, not a single per-kg value). Term and preterm neonates: seek advice from a physician experienced in neonatal care; one possible regimen is 15 mg/kg with interval set by post-menstrual age (24-hourly if <29 weeks; 12-hourly 29-35 weeks; 8-hourly >35 weeks). Doses adjusted to serum trough levels and renal function. Verify against a children's formulary before prescribing.

Dose adjustments

Renal

In renal impairment prefer an initial starting dose followed by serum trough levels rather than a fixed regimen. Mild/moderate impairment: starting dose must not be reduced. Adults: usual start 15-20 mg/kg, which could be given every 24 hours for creatinine clearance 20-49 mL/min. Severe impairment (CrCl <20 mL/min) or on renal replacement therapy: prolong the dosing interval, base subsequent doses on trough levels and residual renal function. Critically ill with renal insufficiency: initial loading dose 25-30 mg/kg should not be reduced. No adjustment for hepatic impairment.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm 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.

Contraindications

Hypersensitivity to vancomycin
Must not be administered intramuscularly (risk of necrosis at the injection site)

Side effects

Flushing of the upper body ('vancomycin infusion reaction'), phlebitis, redness of upper body and face (common)
Renal insufficiency - increased serum creatinine and urea (common)
Decrease in blood pressure (common)
Dyspnoea, stridor (common); increased ALT/AST (common)
Transient or permanent hearing loss (uncommon); hypersensitivity/anaphylactic reactions (rare)

Interactions

Concurrent or sequential nephrotoxic/neurotoxic drugs (e.g. amphotericin B, aminoglycosides, bacitracin, polymyxin B, colistin, viomycin, cisplatin) - monitor renal function (US labelling)
Anaesthetic agents - associated with erythema and histamine-like flushing and anaphylactoid reactions
Other ototoxic substances (e.g. aminoglycosides) - increased risk of ototoxicity; concurrent/sequential use should be avoided

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. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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