Antibiotic — Glycopeptide Pregnancy: Give in pregnancy only if clearly needed, monitoring blood levels carefully to minimise the risk of foetal toxicity; pregnant patients may require significantly increased doses. Vancomycin is excreted in human milk — caution when administered to a nursing woman, although absorption by a nursing infant from the gastro-intestinal tract is unlikely to be significant

Vancomycin (Burns — MRSA)

Brand names: Vancocin

Vancomycin is a glycopeptide antibacterial used intravenously in burns for serious Gram-positive infection, especially meticillin-resistant Staphylococcus aureus, and remains a mainstay agent for confirmed or suspected resistant staphylococcal sepsis in this group.

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 to 20 mg/kg of body weight every 8 to 12 hours (patients aged 12 years and older); in seriously ill patients a loading dose of 25 to 30 mg/kg of body weight can be used to facilitate rapid attainment of target trough serum vancomycin concentration

Route: Intravenous infusion only — give as a slow infusion of at least one hour duration or at a maximum rate of 10 mg/min (whichever is longer), sufficiently diluted (at least 100 ml per 500 mg or at least 200 ml per 1000 mg)

Frequency: Every 8 to 12 hours; the initial dose is based on total body weight and subsequent doses are adjusted on serum concentrations and renal function

Max: Not to exceed 2 g per dose

Source is the SPC for Vancomycin 1000 mg powder for concentrate for solution for infusion. The SPC gives no burns-specific regimen; the nearest stated indication is complicated skin and soft tissue infections, with a suggested treatment duration of 7 to 14 days if non-necrotising and 4 to 6 weeks if necrotising (continue until further debridement is not necessary, the patient has clinically improved and has been afebrile for 48 to 72 hours). Where appropriate, vancomycin should be administered in combination with other antibacterial agents. Therapeutic drug monitoring: therapeutic trough (minimum) blood levels should normally be 10-20 mg/L depending on the site of infection and susceptibility of the pathogen, with trough values of 15-20 mg/L usually recommended to cover pathogens with MIC >= 1 mg/L; in patients with normal renal function measure the serum concentration on the second day of treatment immediately prior to the next dose. Elderly: lower maintenance doses may be required due to the age-related reduction in renal function. Obese patients: the initial dose should be individually adapted according to total body weight as in non-obese patients. Pregnancy: significantly increased doses may be required to achieve therapeutic serum concentrations. Continuous vancomycin infusion may be considered, e.g. in patients with unstable vancomycin clearance. Peri-operative prophylaxis of bacterial endocarditis (all age groups): an initial dose of 15 mg/kg prior to induction of anaesthesia, with a second dose possibly required depending on the duration of surgery. A separate ORAL regimen exists for Clostridioides difficile infection (125 mg every 6 hours for 10 days, increased to 500 mg every 6 hours in severe or complicated disease, maximum daily dose 2 g) — this is not a systemic regimen and must not be used for burn wound infection. No dose adjustment is needed in hepatic insufficiency. NOTE: the eMC fetch was truncated part-way through §4.4, so §4.5 interactions were not retrieved.

Paediatric dose

Route: Intravenous infusion

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

Max: Not stated for this age group in the SPC

SPC §4.2: infants and children aged from one month to less than 12 years — 10 to 15 mg/kg body weight every 6 hours. dosePerKg is left null because the SPC states a range rather than a single value. Patients aged 12 years and older use the adult regimen (15 to 20 mg/kg every 8 to 12 hours). For term and preterm neonates the SPC advises seeking the advice of a physician experienced in the management of neonates and tabulates one possible regimen by post-menstrual age. Paediatric renal dose adjustment is guided by eGFR (revised Schwartz formula), which is not applicable below 1 year of age. Verify all paediatric dosing against a children's formulary before use.

Dose adjustments

Renal

In mild or moderate renal failure the starting dose must NOT be reduced; in severe renal failure it is preferable to prolong the interval of administration rather than administer lower daily doses. The usual adult starting dose of 15 to 20 mg/kg could be administered every 24 hours in patients with creatinine clearance between 20 and 49 ml/min. At creatinine clearance below 20 ml/min or on renal replacement therapy, the timing and amount of subsequent doses depend on the RRT modality and should be based on serum vancomycin trough levels and residual renal function. In the critically ill patient with renal insufficiency the initial loading dose (25 to 30 mg/kg) should not be reduced. Vancomycin is poorly dialysable by intermittent haemodialysis, but high-flux membranes and continuous renal replacement therapy increase clearance and generally require replacement dosing (usually after the haemodialysis session for intermittent haemodialysis)

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.

Contraindications

Hypersensitivity to the active substance
Must not be administered intramuscularly, due to the risk of necrosis at the site of administration

Side effects

Common: flushing of the upper body (vancomycin infusion reaction), exanthema and mucosal inflammation, pruritus and urticaria — associated with too rapid intravenous infusion
Common: decrease in blood pressure; dyspnoea and stridor; phlebitis and redness of the upper body and face
Common: renal insufficiency, manifested primarily by increased serum creatinine and serum urea; increased ALT and AST
Uncommon: transient or permanent loss of hearing; rare vertigo, tinnitus and dizziness
Rare: hypersensitivity and anaphylactic reactions; reversible neutropenia, agranulocytosis, eosinophilia, thrombocytopenia, pancytopenia; interstitial nephritis and acute renal failure
Severe cutaneous adverse reactions including Stevens-Johnson syndrome, toxic epidermal necrolysis, DRESS and AGEP; very rare cardiac arrest and pseudomembranous enterocolitis

Interactions

Other ototoxic substances (e.g. aminoglycosides) — concurrent or sequential use should be avoided; ototoxicity has been reported with excessive intravenous doses or concomitant ototoxic drugs (§4.4)
Teicoplanin — use vancomycin with caution in patients with allergic reactions to teicoplanin, since cross hypersensitivity including fatal anaphylactic shock may occur (§4.4)
Medicines that may cause neutropenia or agranulocytosis — monitor the leukocyte count at regular intervals during concurrent long-term use (§4.4)
US label cross-check: monitor renal function with concurrent and/or sequential systemic or topical use of other potentially neurotoxic and/or nephrotoxic drugs such as amphotericin B, aminoglycosides, bacitracin, polymyxin B, colistin, viomycin or cisplatin; concomitant anaesthetic agents have been associated with erythema and histamine-like flushing
eMC §4.5 was not retrieved by the source fetch (truncated during §4.4) — check the full interactions section against the SPC

Clinical monograph

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.

Reference: ASHP/IDSA/SIDP Vancomycin Monitoring Guidelines 2020; BBA Burns Infection 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.

Calculators

Drugs

Teicoplanin (Burns — MRSA Alternative) · Antibiotic — Glycopeptide