Vanco awareness

What should you be aware of regarding Vancomycin?

by Rose Rohloff

​Vancomycin (Vanco) is an antibiotic, in the classification of Glycopeptide used for gram (+) bacteria, typically used for: 

Methicillin Resistant Staphylococcus Aureus (MRSA); Clostridium Difficile (commonly called C-diff), a potentially deadly infectious 

proliferation of the intestines (often after antibiotic use); and some hospitals are using as the standard protocol for elderly in the emergency room, for asymptomatic pneumonia, and other infections.

​​Clinicians (nurses, doctors, physician assistants, etc.) are supposed to do comprehensive history and physicals (H&Ps) before using any drugs or treatments. And, it is important to know underlying conditions before using Vanco, because it can raise glucose levels, especially in diabetics, and/or cause kidney (renal) insufficiency, especially in elderly. 

The following use case is regarding an admitted primary care doctor as the patient.
"I don't know what the average "lay person" does when they don't have all this information, and without a medical person to look out for them."
"This article is exactly why they stopped Vanco when he had his MRSA infection. His kidneys were starting to get compromised, so they immediately stopped it and started him on a different antibiotic, Daptomycin, which worked just as well and had less side effects for his kidneys and diabetes. Thankfully they caught it very early because of the blood tests they were doing to see what was happening. The new antibiotic was infused only once a day as opposed to twice a day Vanco, and there weren't all the extra blood draws to make sure the kidneys and glucose were doing okay. God is really in control and watching out for us, because the medical field doesn't always do that, even with a fellow medical person."

Vanco and high glucose/hyperglycemia

Vanco and kidney (renal) failure

Changes in vancomycin use in renal failure Stefaan J Vandecasteele 1, An S De Vriese pub in 2010
Abstract A progressive increase in vancomycin resistance with consequent treatment failure has been observed in staphylococci. Therefore, new dosing guidelines advocating much higher vancomycin doses have been issued. Target trough levels of 15-20 microg/ml are proposed. Whether and how these targets can be achieved in patients with chronic kidney disease or those on dialysis are still under evaluation. The higher vancomycin doses to achieve these treatment targets carry a substantial risk for nephrotoxicity. This risk is incremental with higher trough levels and longer duration of vancomycin use. Critically ill patients, patients receiving concomitant nephrotoxic agents, and patients with already compromised renal function are particularly at risk for vancomycin-induced nephrotoxicity.

Elderly patients are more prone to vancomycin toxicity with IV administration due to age-related changes in renal function, the volume of distribution, and accumulation. These patients need to be carefully monitored and require a more conservative dosage regimen. NIH 2022

Acute kidney injury during daptomycin versus vancomycin treatment in cardiovascular critically ill

Conclusions: Daptomycin appears to be safer than vancomycin in terms of AKI risk in ICU patients treated for cardiovascular procedure-related infection. Daptomycin could be considered as a first line treatment to prevent AKI in high-risk patients. NIH 2019