VANCOMY

CIN
 INTRODUCTI
ON
• Vancomycin is an antibiotic produced by soil bacillus streptococcus oreintalis
used to treat a no. of bacterial infections.
• It is a glycopeptide antibiotic used in the prophylaxis and treatment of
infections caused by gram-positive bacteria.
• It is recommended intravenously as a first line treatment for complicated
skin infections, bloodstream infection , endocarditis, bone and joint
infections and meningitis caused by methicillin-resistant S.aureus
• Also used to treat infections of the intestine that cause colitis. (inflammation
of large intestine)
BRAND
NAMES
• Vancocin (ELI LILLI)
• Vancomycin
(ABBOTT)
• Vinjec (BOSCH)
PREPARATIO
NS:
• Capsules.
• Injections soln.
• Injection
Powder.
 INDICATIONS AND
USAGE
• Oral
1.Treatment of clostridium difficile-associated diarrhea.
2.Treatment of staphylococcal enterocolitis.
• Parenteral
1.Treatment of serious infections caused by susceptible strains of
methicillin-resistant (beta lactam resistant) staphylococcoi
1.Treatment of staphylococcal,streptococcal,enterococcal or
diphtheroid endocarditis
 MECHANISM OF
• ACTION
Inhibit Cell wall synthesis by binding with ala-D-
ala
• Inhibit trans glycosylase.
• Alter cell membrane permeability.
• Cell become susceptible to lysis.
PHARMACOKINE
TICS
 ABSORPTION
• Poorly absorbed orally in GIT
• When given parenterally drug distributes widely into
tissues
• Cmax 63mcg/ml.
• Tmax is 1h
 DISTRIBUTION

• 55% protein bound.

• Vd is 0.3 to 0.43 L/kg.
• Distributes well into pleural ,pericardial,
synovial fluid.
 ELIMINATION

• IV: about 75% is excreted in urine by GFR (in 24

hours).
• Mean half life is 4-6hours
• Oral: faeces
 DOSAGE MODIFICATION
• Renal impairment patients:
1.Slow excretion of vancomycin
2.Half life become 7.5 days
3.Dosage adjustment is required.

1.Elderly patients:
1.Total systemic and renal clearance may be reduced.
 TOXIC EFFECTS
• Chills
• Fever
• Phlebitis
• Ototoxicity
• Nephrotoxicity
• Rapid iv infusion may cause diffuse flushing (red man
syndrome).
PRECAUTIO
•NS
Pregnancy : can cause foetal ototoxicity
• Lactation: excreted in milk
• renal function: dose adjustment
• Children: confirm auditory function & serum level
• Elderly: dose adjustment
• Administration: give by secure IV route. May
minimize thrombophlebitis by giving slowly as dilute
infusion.
 CONTRAINDICATIONS

• Hypersensitivity to vancomycin
• Hypersensitivity to corn or corn
product
 OVERDOSE

• Hearing loss
• Increased BUN
• Increased serum
creatinine
• Tinnitus
• vertigo
DRUG
INTERACTIONS
STORAGE AND
STABILITY
RESISTA
NCE
 MECHANISM OF VANCOMYCIN
RESISTANCE
• Vancomycin resistance is acquired by mutation and thickening of
cell wall due to accumulation of excess peptidoglycan. This
seems to be a common resistance mechanism
• Vancomycin binds the D-alanyl-D-alanine dipeptide on the peptide side
chain of newly synthesized peptidoglycan subunit, preventing them from
being incorporated into the cell wall by penicillin-binding protein (PBPs) in
many vancomycin-resistant strains of enterococci the D-alanyl-D-alanine
dipeptide is replaced with D-alanyl-D-lactate, which is not recognised by
vancomycin. Thus, the peptidoglycan subunit is appropriately incorporated
into the cell wall.
• The mechanism of resistance involve the transformation of D-ala-D-ala
linkage in the peptide side chain into D-ala-D-lac i.e replacement of the NH2
group by OH group
• This terminal linkage is still recognized by the essential PBPs (so the cell wall
can still be constructed) but is not recognized by vancomycin (thus resulting
in resistance)
THAN
K YOU