Vancomycin (Paediatric)

How it works

It inhibits bacterial cell-wall synthesis by binding the D-alanyl-D-alanine terminus of peptidoglycan precursors; oral vancomycin acts locally in the gut lumen and is minimally absorbed.

Prescribing in practice

• Intravenous vancomycin is nephrotoxic and ototoxic and requires therapeutic drug monitoring with dose individualisation in children, while rapid infusion can cause an infusion reaction so it must be given slowly.
• Renal function strongly influences clearance, so dosing must account for renal impairment and concurrent nephrotoxic drugs.
• Intravenous and oral routes are not interchangeable; oral is for gut infection only and intravenous dosing should be confirmed against a children's formulary and local microbiology advice.

Monitoring

Monitor vancomycin levels (target trough or AUC per local policy) together with renal function, and watch for infusion reactions and, with prolonged use, hearing changes.

Counselling the patient

• The intravenous medicine is given slowly to avoid a flushing reaction.
• Blood tests are needed to keep the dose in the safe and effective range.
• Report any change in hearing, balance or urine output during treatment.

Evidence & guidelines

Vancomycin is a standard agent for serious paediatric MRSA and Gram-positive infection and for C. difficile, with therapeutic drug monitoring recommended to balance efficacy and toxicity.