Vancomycin adverse effects

Nephrotoxins (N) orototoxins (0) (eg., amphotericin B (N), cisplatin (N/0), cyclosporine (N), furosemide (0), NSAIDs (N), radio contrast (N), vancomycin (N) Additive adverse effects Monitor aminoglycoside SDC and renal function... 

The major adverse effect associated with vancomycin therapy is ototoxicity, which may result in tinnitus, high-tone hearing loss, and deafness in extreme instances. More commonly, the intravenous infusion of vancomycin can result in chills, fever, and a maculopapular skin rash often involving the head and upper thorax (red man syndrome). Red man syndrome is associated with increased levels of serum histamine. Vancomycin is rarely nephrotoxic when used alone. Teicoplanin rarely causes red man syndrome or nephrotoxicity. 

Common adverse effects are diarrhea, nausea, and skin rashes. Impaired liver function (with or without jaundice) and neutropenia sometimes occur. Severe diarrhea and enterocolitis have followed clindamycin administration. Antibiotic-associated colitis that has followed administration of clindamycin and other drugs is caused by toxigenic C difficile. This potentially fatal complication must be recognized promptly and treated with metronidazole, 500 mg orally or intravenously three times a day (the preferred therapy), or vancomycin, 125 mg orally four times a day (less desirable given the increasing prevalence of vancomycin-resistant enterococci). Relapse may occur. 

Adverse effects Side effects are a serious problem with vancomycin and include fever, chills, and/or phlebitis at the infusion site. Shock has occurred as a result of rapid administration. 

VANCOMYCIN NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS-TENOFOVIR, ZIDOVUDINE t adverse effects with zidovudine and possibly tenofovir Additive toxicity Monitor FBC and renal function closely (at least weekly)... 

Adverse effects. The main disadvantage to vancomycin is auditory damage. Tinnitus and deafness may improve if the drug is stopped. Nephrotoxicity and allergic reactions also occur. Rapid i.v. infusion may cause a maculopapular rash possibly due to histamine release (the red person syndrome). 

The response to chloramphenicol has been assessed in cases of bacteremia due to vancomycin-resistant enterococci, of whom 65% received chloramphenicol (6). Among those in whom a response could be assessed, 61% had a clinical response and 79% had a microbiological response. Mortality was non-significantly lower in patients treated with chloramphenicol. In cases with central line-related bacteremia, there was no difference in mortality among those treated with chloramphenicol, line removal, or both. No adverse effect could be definitely attributed to chloramphenicol. 

In 17 patients with suspected postoperative endophthalmitis treated with 0.2 mg vancomycin and 0.05 mg gentamicin intravitreally, there were adequate intravitreal vancomycin and gentamicin concentrations for over a week there were no adverse effects (1). 

The adverse effects of once-daily or twice-daily vancomycin were not significantly different in 121 hospitalized patients (9). Nephrotoxicity developed in 11 and 7.7% of the patients respectively hearing loss in 3.2 and 16% phlebitis in 14 and 23% and red man syndrome in 14 and 9.6%. 

In a prospective, randomized, double-blind, placebo-controlled study in 30 patients who required vancomycin chemoprophylaxis before elective arthroplasty, oral pretreatment with either a histamine Hi receptor antagonist (diphenhydramine 1 mg/kg) or a histamine H2 receptor antagonist (cimetidine 4 mg/kg) significantly reduced the histamine-related adverse effects of rapid vancomycin infusion (18). 

Thrombocytopenia is a rare adverse effect of vancomycin and may be associated with the presence of vancomycin-dependent antiplatelet IgG antibodies. Reports of drug-induced thrombocytopenia have been systematically reviewed (51). Among the 98 different drugs described in 561 articles the following antibiotics were found with level I (definite) evidence co-trimoxazole, rifampicin, vancomycin, sulfisoxazole, cefalothin, piperacillin, methicillin, novobiocin. Drugs with level II (probable) evidence were oxytetracycline and ampicillin. 

A 17-year-old anuric woman with end-stage renal insufficiency received a massive overdose of vancomycin (40 mg/kg/day for 8 days) and was treated three times with high-flux hemodiafUtration with a polysulfone membrane (134). The vancomycin concentration fell from 101 to 17 mg/1 at the end of the procedure. There were no adverse effects of either vancomycin or hemodiafUtration. 

Adverse effects might be produced when vancomycin is administered with other medications. Here are potential adverse reactions ... 

Although the intraperitoneal administration of antibiotics offers a convenient and effective treatment alternative for PD-related peritonitis, potential toxicities should be considered. Chemical peritonitis is a potential toxicity associated with IP vancomycin therapy. A series of early reports of chemical peritonitis with vancomycin snggested that the problem may be brand-specific or associated with large doses (1 to 2 g). One prospective study suggested the incidence may be as high as 23% with IP doses of 1 g or more. There may be a hypersensitivity component to the effect, yet patients exhibiting chemical peritonitis have received subsequent doses without adverse effects. The exact etiology of vancomycin-associated chemical peritonitis remains to be clarified. IP amphotericin B also causes pain and chemical peritonitis. However, since IV amphotericin B poorly penetrates into the peritoneal cavity the therapeutic options are limited. ... 

Nephrotoxicity Renal toxicity usually takes the form of acute tubular necrosis. This adverse effect, which is often reversible, is more common in elderly patients and in those concurrently receiving amphotericin B, cephalosporins, or vancomycin. Gentamicin and tobramycin are the most nephrotoxic. 

Although a number of adverse effects can result from IV infusion (see below), vancomycin has negligible oral activity. It can be used orally for action in the Gl tract, especially in cases of Clostridium difficile... 

The most commonly occurring adverse effects caused by vancomycin are referred to collectively as red man syndrome. Reactions may range from mild pruritus, erythema, and flushing of the upper body to angioedema and rarely hypotension and cardiovascular collapse. Reactions may be prevented or their severity decreased by extending the infusion time and/or premedication with histamine H, and H2 receptor antagonists. 

MANAGING DIARRHEA. Diarrhea may be a sign of a superinfection or pseudomembranous colitis, both of which are adverse reactions tiiat may be seen with the administration of any anti-infective. The nurse checks each stool and reports any changes in color or consistency. When vancomycin is given as part of the treatment for pseudomembranous colitis, it is important to record the color and consistency of each stool to determine the effectiveness of therapy. 

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