Indications: prophylaxis and treatment of endocarditis and other serious infections caused by Gram-positive cocci; treatment of peritonitis associated with peritoneal dialysis added to dialysis fluid.

Cautions: avoid rapid infusion (risk of anaphylactoid reactions); rotate infusion sites; renal impairment; elderly; avoid if history of deafness; all patients require plasma- vancomycin measurement (after 3 or 4 doses if renal function normal, earlier if renal impairment), blood counts, urinalysis, and renal function tests; monitor auditory function in elderly or if renal impairment; pregnancy and breast-feeding.

Side Effects: nephrotoxicity including renal failure and interstitial nephritis; ototoxicity (discontinue if tinnitus occurs); blood disorders including neutropenia (usually after 1 week or cumulative dose of 25 g), rarely agranulocytosis and thrombocytopenia; nausea; chills, fever; eosinophilia, anaphylaxis, rashes (including exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, and vasculitis); phlebitis (irritant to tissue); on rapid infusion, severe hypotension (including shock and cardiac arrest), wheezing, dyspnea, urticaria, pruritus, flushing of the upper body (red man syndrome), pain and muscle spasm of back and chest.

Dose: By intravenous infusion, 1 g every 12 hours; ELDERLY over 65 years, 500 mg every 12 hours or 1 g once daily; CHILD over 1 month, 15 mg/kg every 8 hours (max. 2 g daily)

Endocarditis prophylaxis

Pregnancy: Use only if potential benefit outweighs risk—plasma-vancomycin concentration monitoring essential to reduce risk of fetal toxicity.