Vancomycin

INTRODUCTION

Indications

IV: Treatment of potentially life-threatening infections when less toxic anti-infectives are contraindicated. Particularly useful in staphylococcal infections, including: Endocarditis, Meningitis, Osteomyelitis, Pneumonia, Septicemia, Soft-tissue infections in patients who have allergies to penicillin or its derivatives or when sensitivity testing demonstrates resistance to methicillin.

PO: Treatment of staphylococcal enterocolitis or pseudomembranous colitis due to Clostridium difficile. IV: Part of endocarditis prophylaxis in high-risk patients who are allergic to penicillin.

Action

Binds to bacterial cell wall, resulting in cell death. Therapeutic Effects: Bactericidal action against susceptible organisms. Spectrum: Active against gram-positive pathogens, including Staphylococci (including methicillin-resistant strains of Staphylococcus aureus), Group A beta-hemolytic streptococci, Streptococcus pneumoniae, Corynebacterium, Clostridium difficile, Enterococcus faecalis, Enterococcus faecium.

Adverse Reactions/Side Effects

EENT: ototoxicity. CV: hypotension. GI: nausea, vomiting. GU: nephrotoxicity. Derm: rashes. Hemat: eosinophilia, leukopenia. Local: phlebitis. MS: back and neck pain. Misc: HYPERSENSITIVITY REACTIONS, INCLUDING ANAPHYLAXIS, chills, fever, “red man” syndrome (with rapid infusion), superinfection.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of hypersensitivity reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness, fatigue, or other symptoms.

• Assess any back or neck pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Monitor for signs of eosinophilia (fatigue, weakness, myalgia) or leukopenia (fever, sore throat, signs of infection). Report these signs to the physician.

• Monitor signs of ototoxicity (hearing loss, tinnitus, disturbed balance, vertigo). Report these signs to the physician.

• Report signs of “red man” syndrome, including a red, maculopapular rash that typically appears on the face, neck and upper torso, and may be accompanied by pruritus, urticaria, erythema, angioedema, tachycardia, hypotension, and muscle aches. These signs usually occur during or immediately after rapid IV infusion, and often resolve spontaneously within several hours. Some cases may develop cardiac toxicity, and they should therefore be monitored carefully.

• Monitor injection site for pain, swelling, and irritation. Report prolonged or excessive injection-site reactions to the physician.

Interventions

• Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Employ universal precautions or isolation procedures as indicated for specific patients.

Patient/Client-Related Instruction

• Instruct patient to notify physician immediately of signs of superinfection, including black, furry overgrowth on tongue, vaginal ...