the patient has hearing loss, kidney problems, or an inflammatory intestinal
disorder. Use of vancomycin should be avoided or used with caution for patients
who have a hearing loss. A lower dose of vancomycin should be used for
patients who have kidney problems. Carefully monitor patients who have inflam-
matory intestinal disorders as they are at a higher risk for toxicity. Make sure the
patient has adequate renal function.
When administering vancomycin, don’t give it as an IV bolus. Vancomycin
should be infused over a 24-hour period or infused intermittently over 60 min-
utes. If given continuously for 24 hours, dilute 1–2 grams of vancomycin in a
sufficient amount of .09% sodium chloride (normal saline) or D5W. If infused
intermittently for 60 minutes, dilute the dose in 100 ml of .09% sodium chloride
(normal saline) or dilute in 100 mL of 5% dextrose solution (D5W). Rotation of
the IV sites will help prevent local irritation.
After administering vancomycin, monitor the patient’s renal function to assure
there is adequate volume to excrete vancomycin. Also monitor the patient’s
white blood cell count to determine if the drug is effective.
The patient should be provided with the same instructions as is given to a
patient who is receiving penicillin (see Penicillin and Patient Education).
Vancomycin and Drug-Drug Interactions
Vancomycin has adverse reactions when used with some medications. You must
wait several hours before giving vancomycin to a patient who has received oral
cholestyramine (Questran) or colestipol (Colestid) because these medications
lower the therapeutic effect of vancomycin.
Also avoid giving vancomycin if the patient has taken any aminoglycosides
because they increase the potential for ototoxicity (ear) and nephrotoxicity (kid-
ney). If the patient receives vancomycin and aminoglycosides, then you must
closely monitor vancomycin serum levels to determine that it remains within the
safe range. Drug-drug interaction may occur if administering Vancomycin with:
- Amphotericin B
- Aspirin
- Bacitracin
- Parenteral bumetanide [Bumex]
- Capreomycin [Capastat]
- Cisplatin [Platinol]
- Cyclosporine [Sandimmune]
CHAPTER 13 Antimicrobials—Fighting Infection^227