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Glycopeptide Antibiotic

Vancomycin (Orthopaedic Bone and Joint Infections)

Brand names: Vancomycin, Vancocin

Intravenous vancomycin is a glycopeptide antibacterial for serious Gram-positive infection such as MRSA, including bone and joint 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 cell-wall precursors, an action distinct from beta-lactams and active against many resistant Gram-positive organisms.

Prescribing in practice

  • It requires therapeutic drug monitoring (trough or AUC-guided) to balance efficacy against nephrotoxicity.
  • It is renally cleared and can cause nephrotoxicity and ototoxicity, with greater risk alongside other nephrotoxic or ototoxic drugs.
  • Infusing too rapidly can cause an infusion-related reaction (vancomycin flushing, formerly 'red-man' syndrome), so it is given as a slow infusion.

Monitoring

Monitor vancomycin levels (trough or AUC-guided), renal function and, with prolonged therapy, hearing; adjust dosing to the monitoring results.

Counselling the patient

  • Report flushing, rash or itching during the infusion, which may mean it is running too quickly.
  • Report any change in hearing, ringing in the ears or reduced urine output.

Evidence & guidelines

A mainstay for serious MRSA infection including bone and joint infection; monitored dosing is standard to optimise outcomes and limit toxicity.

Reference: ASHP/IDSA/SIDP Vancomycin Guideline 2020; IDSA Osteomyelitis Guidelines 2012; NICE NG15 (Antimicrobials); SPC Vancomycin; 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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