Vancomycin is a bactericidal agent used for infections of the bone and joints and bacterial septicemia caused by Staphylococcus. It is also used to treat Staphylococcus-causing endocarditis including the methicillin-resistant strains. Prescribers commonly prescribe vancomycin to patients who are susceptible to endocarditis in an effort to prevent the infection.

Vancomycin is also used for the treatment of Clostridium difficile and staphylococcal enterocolitis, which are treated orally or parenterally. However, parenteral vancomycin is not recommended for treating antibiotic-associated pseudomenbranous colitis.

Before administering vancomycin, use the same assessment criteria used for all antibiotic therapy described throughout this chapter. In addition, determine if 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 inflammatory 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 minutes. 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).

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