vancomycin hydrochloride

VANCOMYCIN HYDROCHLORIDEIntravenous use for Methycillin resistant staph aureus bloodstream infections

VANCOMYCIN HYDROCHLORIDE• Antibiotic used to treat infections caused by many gram positive

organisms• Used to treat potentially life-threatening infections in patients who cannot

tolerate other less toxic antimicrobial drugs, or whose infectious organism is resistant to other antimicrobials

• Available as intravenous injection or orally

(“Vancomycin,”2012)

CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTION (CLABSI)

• Bateriemia, a bloodstream infection, is caused by the presence of bacteria in the blood. Often, a gram-positive bacteria, such as MRSA is the cause. Once bacteria enters the blood, often using a central line as a point of entry, it multiplies through simple binary fission.

• Gram-positive bacteria have a cell wall that is composed of multiple layers. The outer membrane is composed of phospholipids, which are complex lipids that contain molecules of phosphate, and lipopolysaccharides. Lipopolysaccharides, often called endotoxins, are released during cell lysis, and result in damage to healthy cells

(Kadner, 2016).

INTENDED DRUG RESPONSE• Vancomycin acts to inhibit cell wall synthesis

of gram-positive bacteria such as MRSA (Abrams, Pennington, & Lammon, 2009).

• It binds to the D-alanyl D alanine portion of the precursor to the cell wall, inhibiting growth. In addition, it alters both the permeability of the cell wall and ribonucleic acid (RNA) synthesis within the cell (Grimone, 2013).

• These actions work to stop the further proliferation of the bacteria, thus reducing and ultimately eliminating the presence of the bacteria in the blood.

POTENTIAL INTERACTIONS• Drug interactions include increased nephrotoxicity and ototoxicity when

used with other aminoglycosides and neuromuscular blocking agents.• Nonsteroidal anti-inflammatory drugs (NSAIDs) can increase the level of

vancomycin in the blood.• There is a risk of lactic acidosis when used with metformin

(G. Kyler, personal communication, April 9, 2016).

ADVERSE DRUG REACTIONS• Renal toxicity • Ototoxicity • “Red man syndrome,” which is flushing and rash on face and upper body when medicine is given by rapid intravenous infusion.


SIDE EFFECTS• Locally, pain at the intravenous injection site and thrombophlebitis may

occur. • Nausea and vomiting are other potential side effects.

("Vancomycin ," 2012).

PHARMACOKINETICS• It is 50 percent bound with serum protein.• It is widely distributed in the body tissues and fluid, except for the

cerebral spinal fluid, unless the meninges are inflamed. • The half-life is 4-8 hours. • Between 80-90 percent of vancomycin is excreted unchanged in the urine

within 24 hours. • Metabolization occurs primarily in the kidneys• It is considered highly protein bound, nutrition levels can affect the

amount of free vancomycin in the blood. (G. Kyler, personal communication, April 9, 2016)

DRUG BINDING ISSUES• Although cholestyramine can decrease absorption of oral vancomycin, there is no known drug which affects the binding of IV vancomycin.


IMPROVING COMMUNICATION• Close collaboration between physicians, nurses and pharmacists must

occur in order to make sure adverse effects and drug interactions are minimized.

• Upon admission to the hospital, nurses should update a medication and allergy list for each patient, entering it into the electronic health record, as well as current patient body measurements.

• Consulting physicians must communicate on prescribed medications. • The physicians must be open to information provided by the pharmacists

and work together to determine the best course of action in the administration of this medication.

(G. Kyler, personal communication, April 9, 2016)

APPLICATION TO PRACTICE SETTING

• The information gathered serves to reinforce the importance of interdisciplinary collaboration, thorough patient screening and documentation of information, and continuous objective patient assessment.

• Lab tests for kidney function should be performed periodically and serum levels of vancomycin should be monitored.

• Because of the risk for ototoxicity, hearing should be assessed during treatment.

• Monitor intake and output, notifying the physician of oliguria or cloudy, pink urine, which are signs of nephrotoxicity

("Vancomycin ," 2012)

REFERENCES• Abrams, A. C., Pennington, S. S., & Lammon, C. B. (Eds.). (2009). Macrolides,

ketolides, and miscellaneous antibacterials. Clinical drug therapy: Rationales for nursing practice (9th ed., pp. 527-540). Philadelphia, PA: Lippincott

Williams & Wilkins.• Grimone, A. J. (2013). Principles of Antimicrobial Therapy. In V. P. Arcangelo, & A. M.

Peterson (Eds.), Pharmacotherapeutics for advanced practice: A practical approach (3rd ed., Ch.8). Retrieved from

www.Kindle-eBooks/b?ie=UTF8&node=154606011• Kadner, R. J. (2016). Bacteria. In Encyclopedia britannica. : Encycloopaedia

Britannica.• Vancomycin hydrochloride. (2012). In B. A. Wilson, M. T. Shannon, & K. M. Shields

(Eds.), Pearson nurse’s drug guide (pp. 1566-1568). Upper Saddle River, NJ: Pearson Education