Vancomycin (Burns — MRSA)

How it works

It inhibits bacterial cell-wall synthesis by binding the D-alanyl-D-alanine terminus of peptidoglycan precursors, preventing polymerisation and cross-linking in susceptible Gram-positive bacteria.

Prescribing in practice

• Therapeutic drug monitoring is essential because the augmented renal clearance and large volume of distribution in major burns frequently lead to subtherapeutic levels, and the agent is also nephrotoxic.
• Infuse intravenously over an adequate period to avoid the histamine-mediated infusion reaction (red-man syndrome) seen with rapid administration.
• Use caution with other nephrotoxic or ototoxic drugs and adjust dosing in renal impairment.

Monitoring

Monitor serum vancomycin levels, renal function and full blood count, recognising that burns pharmacokinetics often demand higher or more frequent dosing.

Counselling the patient

• Blood levels are taken to keep the dose effective and safe, as burns change how the body handles this drug.
• A rapid infusion can cause flushing, so it is given slowly.
• Report rash, hearing changes or reduced urine output.

Evidence & guidelines

Vancomycin is the established intravenous glycopeptide for serious MRSA infection, with altered pharmacokinetics in major burns widely documented.