how to start outpatient vancomycin treatment

Start continuous within 1 hour of next/last intermittent dose Not at steady state OR no levels available Calculate ClCr using IBW, adjust prn for patient-specific factors Use nomogram(s) below Start continuous within 1 hour of next/last intermittent dose C. Vancomycin new start

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Can vancomycin be given as a continuous infusion?

Vancomycin can also be administered as a continuous infusion, when practical, for patients with severe or deep-seated infections (e.g. pneumonia, endocarditis, bone and joint infections). In NHS Grampian only Intensive Care use continuous infusion which is not covered in this guidance– refer to ICU protocol.

What should I know before taking vancomycin capsules?

If you have been prescribed vancomycin capsules for the treatment of C. difficile -associated diarrhea or enterocolitis, take it exactly as directed by your doctor and finish the course. Do not use vancomycin capsules to treat any other type of infection. Vancomycin is not effective for viral infections, such as the flu.

Are hospitalized patients complying with vancomycin guidelines to combat antimicrobial resistance?

The Hospital Infection Control Practices Advisory Committee published guidelines for prudent use of vancomycin to combat increasing resistance to antimicrobial drugs. Studies examining compliance with these guidelines primarily involve hospitalized patients.

How much vancomycin do you give a patient after dialysis?

Vancomycin Dosing Recommendations (Give After Dialysis) Pre-HD Level (preferred) Post HD Level Cp < 10 mcg/mL Give 1000-1500mg IV post dialysis Give 1000mg IV post dialysis Cp 10-15 mcg/mL Give 750-1000mg IV post dialysis Give 500-750mg IV post dialysis Cp 15-20 mcg/mL Give 500-750mg IV post dialysis Give 500mg IV post dialysis

Can vancomycin be given outpatient?

Although only the first referral for home vancomycin was analyzed for each patient, 44 (14.9%) were referred multiple times to receive vancomycin as outpatients (2–8 referrals per patient) during this study.

What is vancomycin protocol?

Initial maintenance dose and interval Typically 15 to 20 mg/kg every 8 to 12 hours for most patients (based on actual body weight, rounded to the nearest 250 mg increment). In general, the approach to establishing the vancomycin dose/interval is guided by a nomogram.

What is the typical route of administration for vancomycin?

Vancomycin is irritating to tissue and must be given by a secure intravenous route of administration. Pain, tenderness, and necrosis occur with inadvertent extravasation. Thrombophlebitis may occur, the frequency and severity of which can be minimized by slow infusion of the drug and by rotation of venous access sites.

What do I need to know before giving vancomycin?

Vancomycin MonitoringVancomycin serum concentrations should be checked to optimize therapy and used as a surrogate marker of effectiveness.Trough, rather than peak, levels should be monitored.Trough levels should be checked just before the fourth dose, when steady-state levels are likely to have been achieved.More items...•

How do you start vancomycin?

Initiating vancomycin treatment with a continuous infusion: Loading dose 20–30 mg/kg is given over 1 hour followed by a continuous infusion. The usual starting dose is 60 mg/kg/day.

When do you start vancomycin after high trough?

Trough: just before 4th dose of a new regimen (prior to 3rd dose for dosing intervals ≥ 24 hours or changing renal function) - Trough levels should be obtained within 30 minutes before the next scheduled dose. - Weekly vancomycin levels should be obtained for long-term vancomycin use with stable renal function. i.

What is the most important consideration for the nurse administering the vancomycin?

Some considerations for nurses administering vancomycin include ensuring a patent IV line, planning for administration of the preoperative dose as much as two hours before the initial incision is made, and including information about the dose and timing of preoperative vancomycin administration in the surgical time out ...

How fast can vancomycin be administered IV?

Vancomycin shall only be administered as slow intravenous infusion of at least one hour duration or at a maximum rate of 10 mg/min (whichever is longer) which is sufficiently diluted (at least 100 ml per 500 mg or at least 200 ml per 1000 mg) (see section 4.4).

Why is vancomycin given slowly?

Slow intravenous administration of vancomycin should minimize the risk of infusion-related adverse effects.

Do you need a PICC line for vancomycin?

Vancomycin via a midline resulted in zero extravasations, zero DVTs and minimal (0.6%) phlebitis. PICCs and CVCs are not required for safe administration if intravenous vancomycin.

Does vancomycin need to go through a central line?

Background. According to the 2011 Infusion Nursing Standards of Practice, the low pH of intravenous vancomycin requires that it be administered through a central line.

What foods should be avoided with vancomycin?

What should you limit or remove from your diet?cruciferous vegetables, such as broccoli, cabbage, cauliflower, and Brussels sprouts.raw vegetables of any kind.spicy food.fried or greasy food.caffeinated beverages.food with a high fat content, such as mayonnaise.beans.More items...

What is the name of the antibiotic that is used to treat a staphylococcal infection?

Intravenous Vancomycin. Vancomycin is an antibiotic originally isolated from the bacteria Streptococcus orientalis. It was discovered in the 1950’s but became a preferred treatment against infections resistant to other antibiotics, particularly penicillin-resistant staphylococcal infections. Vancomycin is a tricyclic glycopeptide antibiotic ...

How long does it take for red man syndrome to develop?

When intravenous vancomycin is administered too quickly, red man syndrome can develop. Symptoms that often begin 4 to 10 minutes after administration include: Between 3.7% to 47% of patients develop red man syndrome. The faster the infusion of vancomycin, the more likely someone is to develop the syndrome.

Does vancomycin cause kidney damage?

In some cases, ototoxicity induced by vancomycin treatment may be irreversible. Vancomycin also exhibits nephrotoxicity and has been found to cause acute kidney injury (AKI). The most likely explanation is that vancomycin induces oxidative effects on the renal tubules, restricting blood flow and oxygen to the organ.

Is vancomycin good for diarrhea?

Oral vancomycin is given to treat Clostridiodes ( Clostridium) difficile infections and infection-induced diarrhea. However, the drug has poor oral bioavailability and is broken down in the stomach and intestines before it can enter the bloodstream to treat systemic infections.

Can you do vancomycin at a different rate?

Every person will process vancomycin at a different rate and dosing can be tailored to an individual patient. Recent pharmacokinetic studies have provided an equation for estimating daily maintenance dosing of vancomycin in obese patients.

Can vancomycin be overdosed?

Vancomycin has a narrow therapeutic window, and it is easy to underdose or overdose a patient. Blood work is done to ensure vancomycin trough levels remain within this window to prevent organ damage or antibiotic resistance. This also helps to determine when the next dose should be administered to the patient.

Can vancomycin be used for eye infections?

Bacterial infections in the eye (bacterial endophthalmitis) Vancomycin is also useful for treating infections in patients allergic to penicillin or cephalosporins. It is important to note that vancomycin and other antibiotics are not effective in treating viral infections.

How long does vancomycin last?

The usual duration of therapy is seven to ten days. 7. Interactions. Medicines that interact with vancomycin may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with vancomycin.

What are the side effects of vancomycin?

Nausea, abdominal pain, vomiting, diarrhea, flatulence, and low potassium levels are the most common side effects associated with vancomycin capsules. Edema, back pain, urinary tract infection, and a headache may also occur .

What is the purpose of vancomycin capsules?

2. Upsides. Vancomycin capsules are usually only used to treat Clostridium difficile -associated diarrhea and enterocolitis caused by Staphylococcus aureus.

What medications interact with vancomycin?

Common medications that may interact with vancomycin include: amikacin. aminoglycosides, such as gentamicin or tobramycin. bile acid sequestrants, such as colestipol or cholestyramine. lactobacillus. NSAIDs such as ibuprofen, diclofenac, or naproxen. piperacillin. sirolimus or tacrolimus. sodium picosulfate.

How long does it take for a syringe to go away?

Most reactions resolve within 20 minutes; however, some may persist for several hours. May not be suitable for some people including those with inflammatory bowel disease (including Crohn's disease or ulcerative colitis), kidney disease, or hearing loss.

Is vancomycin absorbed into the bloodstream?

difficile -associated diarrhea or enterocolitis when given orally, or other severe infections when given intravenously (IV). Oral dosages are not typically absorb ed into the bloodstream; however, people with inflammatory diseases of the colon may be at risk. Higher dosages and IV use of vancomycin increase the risk of ear and kidney side effects.

Can you take vancomycin for diarrhea?

difficile -associated diarrhea or enterocolitis, take it exactly as directed by your doctor and finish the course. Do not use vancomycin capsules to treat any other type of infection.

Does Opat recommend antimicrobials?

Apart from vancomycin, however, the OPAT guidelines lack information regarding choices of antimicrobial drugs for outpatients. In addition, they do not clearly prioritize conscientious use of antimicrobial drugs above other considerations, such as cost and dosing convenience, when choosing outpatient therapy.

Is vancomycin safe for home infusion?

Recommendations for prudent vancomycin use are often overlooked when selecting antimicrobial drugs for home infusion. The public health impact of this practice remains unknown. Vancomycin is an important agent for the treatment of serious infections caused by gram-positive bacteria ( 1 ).

Why is vancomycin used for drug monitoring?

Vancomycin therapeutic drug monitoring has been advocated to maintain drug concentrations within a narrow therapeutic index and to lessen the potential for drug-induced nephrotoxicity and ototoxicity. Although some debate still occurs about the conflicting evidence regarding the use of vancomycin concentrations to predict and prevent drug effectiveness or toxicity, vancomycin therapeutic drug monitoring has been widely adopted.1

What is vancomycin used for?

Vancomycin has been in clinical use for over 50 years to treat Gram-positive bacterial infections. It was initially used as a penicillin alternative to treat penicillinase-producing strains of Staphylococcus aureus, and is now commonly employed against other Gram-positive infections such as those caused by methicillin-resistant Staphylococcus aureus (MRSA) species and drug-resistant Streptococcus and Enterococcus species.1 Optimal use of vancomycin is of great importance among hospitalized patients due to the high morbidity and mortality associated with infections caused by these organisms.2 The dosing and monitoring of vancomycin need to be optimized to maximize efficacy and minimize toxicity.1 Evaluation of the clinical necessity for vancomycin use is paramount as inappropriate utilization of vancomycin has the potential to promote the development of resistance to vancomycin.2 Despite the recent development of antibiotics for Gram-positive infections, vancomycin remains the primary agent in the treatment of drug-resistant Gram-positive infections.

What is clinical practice guidelines?

This guideline outlines the preferred approach for most patients. It is not intended to replace a clinician’s judgment or to establish a protocol for all patients. It is understood that some patients will not fit the clinical condition contemplated by a guideline and that a guideline will rarely establish the only appropriate approach to a problem.

How did the guideline workgroup adopt recommendations?

The workgroup members agreed to adopt recommendations developed by consensus through discussion of the literature and expert experience. All recommendations endorsed or developed by the guideline workgroup were reviewed and approved by other stakeholders or committees.

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