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Pharmacologic class: Tricyclic glycopeptide
Therapeutic class: Anti-infective
Pregnancy risk category C (with parenteral use); B (with oral use)
Binds to bacterial cell wall, inhibiting cell-wall synthesis and causing secondary damage to bacterial membrane
Capsules: 125 mg, 250 mg
Powder for injection: 500-mg vial, 1-g vial, 5-g vial, 10 g-vial
Indications and dosages
➣ Severe, life-threatening infections caused by susceptible strains of methicillin-resistant staphylococci, Staphylococcus epidermidis, Streptococcus viridans or Streptococcus bovis (alone or combined with an aminoglycoside), or Enterococcus faecalis (combined with an aminoglycoside)
Adults: 500 mg I.V. q 6 hours or 1 g I.V. q 12 hours
Children: 10 mg/kg I.V. q 6 hours
Infants and neonates: Initially, 15 mg/kg I.V., followed by 10 mg/kg I.V. q 8 hours in infants 8 days to 1 month old, or 10 mg/kg I.V. q 12 hours in infants less than 8 days old
➣ Endocarditis prophylaxis in penicillin-allergic patients at moderate risk who are scheduled for dental and other invasive procedures
Adults: 1 g I.V. slowly over 1 to 2 hours, with infusion completed 30 minutes before invasive procedure begins
Children: 20 mg/kg I.V. over 1 to 2 hours, with infusion completed 30 minutes before invasive procedure begins
➣ Enterocolitis caused by Staphylococcus aureus
Adults: 500 mg to 2 g P.O. daily in three or four divided doses for 7 to 10 days
Children: 40 mg/kg P.O. daily in three or four divided doses for 7 to 10 days; total daily dose shouldn't exceed 2 g.
➣ Clostridium difficile-associated diarrhea
Adults: 125 mg P.O. q.i.d. for 10 days
Children: 40 mg/kg P. O. in three or four divided doses for 7 to 10 days; total daily dose shouldn't exceed 2 g.
• Renal impairment
• Elderly patients
• Intraocular infections
• Febrile neutropenia
• Hypersensitivity to drug
Use cautiously in:
• renal impairment, preexisting hearing loss
• concurrent use of anesthetics, immunosuppressants, or nephrotoxic or ototoxic drugs
• elderly patients
• pregnant or breastfeeding patients
Know that I.V. therapy is ineffective against enterocolitis and pseudomembranous diarrhea.
• For intermittent I.V. infusion, dilute by adding 10 or 20 ml of sterile water for injection to vial containing 500 mg or 1 g of drug, respectively, to yield a concentration of 50 mg/ml. Dilute further by adding at least 100 ml or 200 ml, respectively, of dextrose 5% in water or normal saline solution; infuse over at least 1 hour.
• Don't give by I.M. route.
• Be aware that capsules aren't systemically absorbed; therefore, oral therapy is ineffective in infections other than C. difficile-associated diarrhea and enterocolitis caused by S. aureus.
Keep emergency equipment and epinephrine on hand in case of anaphylaxis.
CV: hypotension, cardiac arrest, vascular collapse
EENT: permanent hearing loss, ototoxicity, tinnitus
GI: nausea, vomiting, abdominal pain, pseudomembranous colitis
GU: nephrotoxicity, severe uremia
Hematologic: eosinophilia, leukopenia, neutropenia
Respiratory: wheezing, dyspnea
Skin: "red man" syndrome (nonallergic histamine reaction with rapid I.V. infusion), rash, urticaria, pruritus, necrosis
Other: chills, fever, thrombophlebitis at injection site, anaphylaxis
Drug-drug. Aminoglycosides, amphotericin B, bacitracin, cephalosporins, cisplatin, colistin, nondepolarizing neuromuscular blockers, pentamidine (with parenteral use): increased risk of nephrotoxicity and ototoxicity
Anesthetic agents (with parenteral use): erythema and histamine-like flushing
Drug-diagnostic tests. Albumin, blood urea nitrogen (BUN), creatinine: increased levels
Eosinophils, neutrophils: decreased counts
Potassium: decreased level
Monitor closely for signs and symptoms of hypersensitivity reactions, including anaphylaxis.
• Check drug blood level weekly. Therapeutic peak ranges from 30 to 40 g/L; therapeutic trough, 5 to 10 mg/L.
• Assess BUN and creatinine levels every 2 days, or daily in patients with unstable renal function.
• Monitor urine output daily. Weigh patient at least weekly.
• Assess hearing before and during therapy; stay alert for hearing loss. Patient may require baseline and weekly audiograms.
• Check I.V. site often for phlebitis.
• Watch for "red-man" syndrome, which can result from rapid infusion. Signs and symptoms include hypotension, pruritus, and maculopapular rash on face, neck, trunk, and limbs.
• Monitor CBC. Watch for signs and symptoms of blood dyscrasias.
• Closely monitor respiratory status. Stay alert for wheezing and dyspnea.
Monitor vital signs and cardiovascular status, especially for vascular collapse and other signs of impending cardiac arrest.
• Tell patient he may take with or without food.
• Instruct patient to take oral drug exactly as prescribed for as long as prescribed, even if symptoms improve.
• Explain importance of prophylactic I.V. therapy to patients at risk for endocarditis who are scheduled for invasive procedures.
Advise patient to promptly report rash, hearing loss, breathing problems, and signs and symptoms of "red-man" syndrome, nephrotoxicity, and blood dyscrasias.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.