ISSN 2398-2977      

Vancomycin

pequis
Contributor(s):

Patricia Dowling

Scott Weese


Introduction

Name

  • Vancomycin.

Class of drug

  • Glycopeptide antimicrobial, a fermentation product of Streptomyces orientalis.

Description

Chemical name

  • (1S,2R,18R,19R,22S,25R,28R,40S)-48-[(2S,3R,4S,5S,6R)-3-[(2S,4S,5S,6S)-4-amino-5-hydroxy-4,6-dimethyloxan-2-yl]oxy-4,5-dihydroxy-6-(hydroxymethyl)oxan-2-yl]oxy-22-(2-amino-2-oxoethyl)-5,15-dichloro-2,18,32,35,37-pentahydroxy-19-[[(2R)-4-methyl-2-(methylamino)pentanoyl]amino]-20,23,26,42,44-pentaoxo-7,13-dioxa-21,24,27,41,43-pentazaoctacyclo[26.14.2.23,6.214,17.18,12.129,33.010,25.034,39]pentaconta-3,5,8(48),9,11,14,16,29(45),30,32,34(39),35,37,46,49-pentadecaene-40-carboxylic acid.

Molecular formula

  • C66H75Cl2N9O24.

Molecular weight

  • 1449.2.

Physical properties

  • White solid, soluble in water.

Storage requirements

  • Stable for 2 weeks at room temperature when reconstituted with sterile water for injection.

Uses

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Indications

  • As a “last resort” antimicrobial for humans, systemic vancomycin should only be used in horses to treat methicillin-resistant staphylococcal Methicillin-resistant Staphylococcus aureus and enterococcal infections when there are no other viable treatment options. However, there are typically other viable treatment options for these infections.
  • Oral vancomycin is not absorbed and is only indicated for treatment of enteric infections. It is used to treat C. difficile in humans but data supporting a need for this in horses are lacking and limited information is available about optimal dosing.
  • Local administration in impregnated beads, gels or other matrices, or through regional limb or intraosseous perfusion can be viable treatment options. 
  • The decision to use vancomycin to treat a highly resistant pathogen in a veterinary patient should include consideration of the health risks to others, both human and animal, in contact with the patient.
  • An effective biosecurity program is mandatory in such situations.

Administration

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Pharmacokinetics

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Precautions

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Interactions

with other drugs

  • In vitro, the antimicrobial effects of vancomycin and aminoglycosides are synergistic against many strains of Staphylococcus aureus, streptococci, and enterococci. However, concomitant use of vancomycin and aminoglycosides is associated with an increased risk of ototoxicity and/or nephrotoxicity.

Adverse Reactions

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Further Reading

Publications

Refereed Papers

  • Recent references from PubMed and VetMedResource.
  • Wijesekara P N K, Kumbukgolla W W, Jayaweera J et al (2017) Review on Usage of Vancomycin in Livestock and Humans: Maintaining Its Efficacy, Prevention of Resistance and Alternative Therapy. Vet Sci 4, 6 PubMed.
  • Rubio-Martinez L M, Lopez-Sanroman J, Cruz A M et al (2006) Evaluation of safety and pharmacokinetics of vancomycin after intraosseous regional limb perfusion and comparison of results with those obtained after intravenous regional limb perfusion in horses. Am J Vet Res 67, 1701-1707 PubMed.
  • Orsini J A, Snooks-Parsons C, Stine L et al (2005) Vancomycin for the treatment of methicillin-resistant staphylococcal and enterococcal infections in 15 horses. Can J Vet Res 69, 278-286. PubMed.
  • Orsini J A, Ramberg C F Jr, Benson C E et al (1992) Vancomycin kinetics in plasma and synovial fluid following intravenous administration in horses. J Vet Pharmacol Ther 15, 351-363. PubMed.

Other sources of information

  • Giguère S, Prescott JF, Dowling PM, Eds (2013) Antimicrobial Therapy in Veterinary Medicine, 5th ed. Wiley Blackwell.
  • Cole C, Bentz B, Maxwell L (2014) Equine Pharmacology, Wiley Blackwell.
  • Plumb DC (2018) Plumb’s Veterinary Drug Handbook, Wiley Blackwell. Online version at https://app.plumbs.com.

Organisation(s)

  • National Office of Animal Health (NOAH) Compendium of Data Sheets for Animal Medicines. Website: www.noahcompendium.co.uk.

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