Out of hours: How to make vancomycin oral liquid for the

treatment of Clostridium difficile infection

 Missed or delayed doses of vancomycin for treatment of C.difficile can lead to recurrent
infection.
 During working hours, your ward pharmacist will order a supply, which will have a 7 day
expiry and must be kept in the fridge.
 The oral liquid should only be prepared on the ward out of hours
 Oral vancomycin liquid is not kept as ward stock.
 Vancomycin 500mg vials can be used to prepare a solution for oral/NG/PEG
administration (see instructions below).
 The doses must be administered promptly when it is due.
Do not wait until the next medication round starts. Do not omit a dose.

Preparation of oral vancomycin liquid (out of hours ONLY)

1. Reconstitute one vancomycin 500mg vial with 10mL water for injection
2. Document the time and date on the vial once reconstituted
3. Withdraw 2.5mL (125mg) from the reconstituted vial and mix in 30mL sterile water
(can also be mixed in fruit squash to improve taste)
4. Administer dose to patient
5. Store remaining reconstituted vial in the fridge. Discard vial after 24 hours safely.

One vancomycin 500mg vial will provide 1 day’s treatment (125mg QDS, i.e. 4 doses)

Be proactive in ordering a supply before the dose is due

Pharmacy Opening Hours:

Contact usual ward pharmacy team or inpatient pharmacy (65168 SJUH, 23291 LGI) to supply oral
vancomycin liquid
Monday - Friday: 9am - 8pm
Saturday - Sunday: 9am - 5pm
Out of hours:
After 19:30, contact the on-call pharmacist on bleep 80-1247 to supply vial.

References
Electronic Medicine Compendium 2019. Vancomycin 1000mg powder for concentrate for solution for infusion vials. EMC. Available from
https://www.medicines.org.uk/emc/product/8760/smpc [Accessed 21 February 2023]

Injectable Medicines Guide. 2018. Vancomycin. [Online]. [Accessed 21 February 2023]. Available from
https://medusa.wales.nhs.uk/IVGuideDisplay.asp

Document adapted from RCA outcome by Farah Malik (Specialist Clinical Pharmacist - Elderly Medicine)
Author: Caroline Walker (Pharmacy Infection Team (PIT), Oct 2020; Reviewed: Sarah Hackney, ACP in PIT, Feb 2023.
QA check: Sophie Carter, Formulary Manager, Feb 2023
Next review due: Feb 2026