Clostridium difficileinfection [first episode]
▶BY MOUTH
▶Child 12–17 years: 125 mg every 6 hours for 10 days;
increased if necessary to 500 mg every 6 hours for
10 days, increased dose if severe or complicated
infection
Clostridium difficileinfection [multiple recurrences]
▶BY MOUTH
▶Child 12–17 years: 125 mg every 6 hours for 10 days,
followed by, either tapering the dose (gradually
reducing until 125 mg daily) or a pulse regimen
( 125 – 500 mg every 2 – 3 days for at least 3 weeks)
Complicated skin and soft tissue infections|Bone
infections|Joint infections|Community-acquired
pneumonia|Hospital-acquired pneumonia [including
ventilator-associated pneumonia]|Infective
endocarditis|Acute bacterial meningitis|Bacteraemia
[occurring in association with or suspected to be
associated with the licensed indications]
▶BY INTRAVENOUS INFUSION
▶Neonate up to 29 weeks corrected gestational age
(administered on expert advice): 15 mg/kg every 24 hours
adjusted according to plasma-concentration
monitoring, duration should be tailored to type and
severity of infection and the individual clinical
response—consult product literature for further
information.▶Neonate 29 weeks to 35 weeks corrected gestational age
(administered on expert advice): 15 mg/kg every 12 hours
adjusted according to plasma-concentration
monitoring, duration should be tailored to type and
severity of infection and the individual clinical
response—consult product literature for further
information.▶Neonate 35 weeks corrected gestational age and above
(administered on expert advice): 15 mg/kg every 8 hours
adjusted according to plasma-concentration
monitoring, duration should be tailored to type and
severity of infection and the individual clinical
response—consult product literature for further
information.▶Child 1 month–11 years: 10 – 15 mg/kg every 6 hours
adjusted according to plasma-concentration
monitoring, duration should be tailored to type and
severity of infection and the individual clinical
response—consult product literature for further
information, doses higher than 60 mg/kg/day cannot be
generally recommended as the safety of increased
dosing has not been fully assessed
▶Child 12–17 years: 15 – 20 mg/kg every 8 – 12 hours (max.
per dose 2 g) adjusted according to plasma-
concentration monitoring, duration should be tailored
to type and severity of infection and the individual
clinical response—consult product literature for
further information, in seriously ill patients, a loading
dose of 25 – 30 mg/kg (usual max. 2 g) can be used to
facilitate rapid attainment of the target trough serum-
vancomycin concentration
Perioperative prophylaxis of bacterial endocarditis [in
patients at high risk of developing bacterial endocarditis
when undergoing major surgical procedures]
▶BY INTRAVENOUS INFUSION
▶Neonate: 15 mg/kg, to be given prior to induction of
anaesthesia, a second dose may be required depending
on duration of surgery.▶Child: 15 mg/kg, to be given prior to induction of
anaesthesia, a second dose may be required depending
on duration of surgery
Surgical prophylaxis (when high risk of MRSA)
▶BY INTRAVENOUS INFUSION
▶Child:(consult local protocol)
CNS infection e.g. ventriculitis (administered on expert
advice)
▶BY INTRAVENTRICULAR ADMINISTRATION
▶Neonate: 10 mg every 24 hours.▶Child: 10 mg every 24 hours, for all children reduce to
5 mg daily if ventricular size reduced or increase to
15 – 20 mg once daily if ventricular size increased,
adjust dose according to CSF concentration after
3 – 4 days; aim for pre-dose (’trough’) concentration
less than 10 mg/litre. If CSF not draining free reduce
dose frequency to once every 2 – 3 days
Peritonitis associated with peritoneal dialysis
▶BY INTRAPERITONEAL ADMINISTRATION
▶Child:Add to each bag of dialysisfluid to achieve a
concentration of 20 – 25 mg/litre
Eradication of meticillin-resistantStaphylococcus aureus
from the respiratory tract in cystic fibrosis
▶BY INHALATION OF NEBULISED SOLUTION
▶Child: 4 mg/kg twice daily (max. per dose 250 mg) for
5 days, alternatively 4 mg/kg 4 times a day (max. per
dose 250 mg) for 5 days
PHARMACOKINETICS
▶Vancomycin shouldnotbe given by mouth for systemic
infections because it is not absorbed significantly.lUNLICENSED USEVancomycin doses in BNF publications
may differ from those in product literature. Use of
vancomycin (added to dialysisfluid) for the treatment of
peritonitis associated with peritoneal dialysis is an
unlicensed route. Not licensed for intraventricular use or
inhalation. Not licensed for use by theintrathecalroute for
the treatment of meningitis.IMPORTANT SAFETY INFORMATION
SAFE PRACTICE
For intraventricular administration, seek specialist
advice.lCONTRA-INDICATIONS
▶With intravenous usePrevious hearing loss
lCAUTIONS
▶With intravenous usePremature neonates (monitor serum-
concentration carefully).young infants (monitor serum-
concentration carefully)
▶With oral useSystemic absorption may be enhanced in
patients with inflammatory disorders of the intestinal
mucosa or withClostridium difficile-induced
pseudomembranous colitis (increased risk of adverse
reactions)
lINTERACTIONS→Appendix 1 : vancomycin
lSIDE-EFFECTS
GENERAL SIDE-EFFECTSAgranulocytosis.dizziness.drug
fever.eosinophilia.hypersensitivity.nausea.nephritis
tubulointerstitial.neutropenia (more common after
1 week or cumulative dose of 25g).renal failure.severe
cutaneous adverse reactions (SCARs).skin reactions.
thrombocytopenia.tinnitus (discontinue).vasculitis.
vertigo
SPECIFIC SIDE-EFFECTS
▶With intravenous useBack pain.bradycardia.cardiac arrest
(on rapid intravenous injection).cardiogenic shock (on
rapid intravenous injection).chest pain.dyspnoea.
hearing loss.hypotension.muscle complaints.326 Bacterial infection BNFC 2018 – 2019
Infection5