VANCOMYCIN
Drugs in Pregnancy and Lactation.
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Name: VANCOMYCIN
Class: Antibiotic
Risk Factor: BM
Fetal Risk Summary
Vancomycin is an antibiotic that is used for Gram-positive bacteria when either the organisms are resistant to less toxic anti-infectives (e.g., penicillins and cephalosporins) or the patient is sensitive to these agents.
Reproduction studies in rats and rabbits at doses up to 1 and 1.1 times the maximum recommended human dose based on body surface area [MRHD]), respectively, have revealed no teratogenic effects (1). No effects on fetal weight or development were seen with the same doses in rats or slightly lower doses in rabbits (0.74 times the MRHD).
No cases of congenital defects attributable to vancomycin have been located. The manufacturer has received reports on the use of vancomycin in pregnancy without adverse fetal effects (A.F. Crumley, personal communication, Eli Lilly, 1983).
The pharmacokinetics of vancomycin in a woman at 26.5 weeks' gestation were described in a 1991 Reference (2). Accumulation of the antibiotic, administered as 1 g IV every 12 hours (15 mg/kg/dose), was demonstrated in amniotic fluid (1.02 µg/mL on day 1; 9.2 µg/mL on day 13). At delivery at 28 weeks' gestation, cord blood levels were 3.65 µg/mL (6 hours after the mother's maximum serum concentration), 76% of the mother's serum level. The newborn's serum level, 3.25 hours after birth, was 2.45 µg/mL, indicating a half-life in the infant of 10 hours (2).
Vancomycin was used for subacute bacterial endocarditis prophylaxis in a penicillin-allergic woman at term with mitral valve prolapse (3). One hour before vaginal delivery, a 1-g IV dose was given during 3 minutes (recommended infusion time is 60 minutes [1,4]). Immediately after the dose, maternal blood pressure fell from 130/74 to 80/40 mm Hg and then recovered in 3 minutes. Fetal bradycardia, 90 beats/minute, persisted for 4 minutes. No adverse effects of the hypotension-induced fetal distress were observed in the newborn. The Apgar scores were 9 and 10 at 1 and 5 minutes, respectively.
A 1989 report examined the effects of multiple-dose vancomycin on newborn hearing and renal function (5). Ten pregnant, drug-dependent women were treated with IV vancomycin (1 g every 12 hours for at least 1 week) for suspected or documented infections caused by methicillin-resistant Staphylococcus aureus. Four of the 10 women also received concomitant gentamicin. Two control groups, neither of which received antibiotics, were formed: 10 infants from non-drug-dependent mothers (group II), and 10 infants from drug-dependent mothers (group III). Auditory brainstem response testing was conducted on the infants at birth and at 3 months of age, and blood urea nitrogen and serum creatinine were measured at birth. The placental transfer of vancomycin was measured in two patients with cord blood levels of 16.7 and 13.2 µg/mL, 6 and 2.5 hours after infusion, respectively. At birth, abnormal auditory brainstem responses were measured in a total of six infants: two infants from the study group (neither was exposed to gentamicin), three from control group II, and one from control group III. The hearing defect in all six infants was an absent wave V at 40 dB (the average behavioral threshold of adult listeners) in one or both ears. Repeat testing at 3 months in five infants was normal, indicating that the initial tests were falsely positive (5). In the sixth infant (one from the study group), the tests at 3 months again showed no response in either ear at 40 dB. This infant's mother had received a 2-g vancomycin dose after initial dosing had produced low serum levels (<20 µg/mL) of the antibiotic. The peak serum level obtained following the double dose was 65.7 µg/mL, a potentially toxic level if it was maintained. Following this, the mother was treated with the same regimen as the other women. On further examination, however, reduced compliance was discovered in both ears and the loss of hearing was diagnosed as a conduction defect, rather than sensorineural. Tests at 12 months, following improved compliance in both ears, were normal. Renal function studies in all 30 infants were also normal, although this latter conclusion has been challenged (6) and defended (7).
Breast Feeding Summary
Vancomycin is excreted into breast milk. In one woman treated with IV vancomycin (1 g every 12 hours for at least 1 week), a milk level 4 hours after a dose was 12.7 µg/mL (5). This value was nearly identical to the serum trough concentration measured at 12 hours in the mother during pregnancy. The effect on the nursing infant of vancomycin in milk is unknown. Vancomycin is poorly absorbed from the normal, intact gastrointestinal tract, and thus, systemic absorption would not be expected (4). However, three potential problems exist for the nursing infant: modification of bowel flora, direct effects on the infant (e.g., allergic response or sensitization), and interference with the interpretation of culture results if a fever workup is required.
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References
- Product information. Vancocin. Eli Lilly, 2000.
- Bourget P, Fernandez H, Delouis C, Ribou F. Transplacental passage of vancomycin during the second trimester of pregnancy. Obstet Gynecol 1991;78:908–11.
- Hill LM. Fetal distress secondary to vancomycin-induced maternal hypotension. Am J Obstet Gynecol 1985;153:74–5.
- American Hospital Formulary Service. Drug Information 1997. Bethesda, MD: American Society of Health-System Pharmacists, 1997:403–8.
- Reyes MP, Ostrea EM Jr, Cabinian AE, Schmitt C, Rintelmann W. Vancomycin during pregnancy: Does it cause hearing loss or nephrotoxicity in the infant? Am J Obstet Gynecol 1989;161:977–81.
- Gouyon JB, Petion AM. Toxicity of vancomycin during pregnancy. Am J Obstet Gynecol 1990;163:1375–6.
- Reyes MP, Ostrea EM Jr. Toxicity of vancomycin during pregnancy. Reply. Am J Obstet Gynecol 1990;163:1376.
Q&A about Vancomycin
my father is taking vancomycin by IV injection at home. He was taking the same antibiotic while in the hospital. He has taken 3 doses here at home is now complaining about feeling gassy. He does not have diarrhea just has a lot of gas. Says his stomach "doesn't feel quite right". Any suggestion for help? Do you think he is getting too much antibiotic too quickly? Should he be lying down as opposed to sitting up in a chair?? Please help!!
Patients who develope GI symptoms like your dad should have his stool cultured for the bad bacteria. If that test is negative I would consider adding yogurt to his diet to help restore some of the good bacteria.
My 3 month old child has meningitis and after 1 month in the hospital I was send home to give my child intravenous Vancomycin and Rocephin. A nurse came to my home to show me how to do it. Only took her 1 hour to show me how and she said if I did not do it right I can make my child go deaf. But I want to know if is legal in california for a non certified person to give this type of medicine.
My mother has MRSA and is taking vancomycin IV, has anyone had side effects? She is in a nursing home and has a rash all over her body. I spoke to a doctor today and they are going to give her some kind of steroid medication an hour before the vancomycin. Has this happened to anyone else and did the steroid medication work?
The tapering of the dose is to allow the normal flora to regrow whilst also helping prevent the infection from recurring (some C. diff spores may remain even during vancomycin therapy.)
Hope this answers your question.
Hes taking it for a staff infection in his foot. He also has rheumatoid arthritis and was on Enbrel prior to infection and antibiotic. Hes got high blood pressure. He was taking Toprol 50 mg a day and Avalide 150 mg a day for that. They changed his IV at home from 1 gram twice a day to 2 grams once a day. No one ever told him to infuse slower! So in the first 15 min he got extremely itchy and rash all over - redmans syndrome. About 8 hours later we took him to the ER because he had a fever of 102. Turns out he was in full renal failure. I read that blood pressure med plus vanco and serious injury or illness can cause renal faliure. What I want to know is because he infused to fast err on part of the Home Health agency, did that cause him to go into renal failure?
There are some blood pressure medications that can cause decreased renal function. The ACE inhibitors like lisinopril, enalapril, etc can decrease kidney function which could lead to higher vancomycin levels, which could further contribut to the renal failure. This type of renal failure is usually reversible after the medications causing the failure are removed.
I hope that made sense- It sounded redundant to me but is is difficult to explain simply in a couple of paragraphs.
Tetracycline works in an entirely different way than Penicillin and Vanco, so when an antibiotic is selected to treat an infection, it's based on its mechanism of action, ability to kill sufficiently (sensitivity profile), and other very sophisticated factors.
Bugs are very clever, naughty little critters, so really bright scientists constantly have to figure out ways to keep them from getting their way.
I have never heard of this medical term, and google and wikipedia are not helping via exact matches.
Can anyone tell me what it is, or a site that will tell me exactly what I need to know? Thanks for your responses.
Will I be at home or in a hositpal...does it make me really sick?
