Vancocin (Vancomycin)
Glycopeptide antibiotic for Clostridioides difficile colitis
Quick Facts About Vancocin
Key Takeaways About Vancocin
- First-line treatment for C. difficile: Oral vancomycin is recommended as a primary therapy for Clostridioides difficile infection by IDSA/SHEA and ESCMID guidelines
- Local gut action only: Oral vancomycin is not significantly absorbed and acts directly in the intestine, minimizing systemic side effects
- Complete the full course: Always finish all 10 days of treatment even if symptoms improve, to reduce the risk of recurrence
- Recurrence risk exists: Up to 20-25% of patients experience CDI recurrence after initial treatment; extended or tapered courses may be needed
- Report serious skin reactions: Stop the medication and seek immediate medical attention if you develop severe skin rash, blistering, or mouth sores
What Is Vancocin and What Is It Used For?
Vancocin contains vancomycin hydrochloride, a glycopeptide antibiotic that kills bacteria by preventing cell wall synthesis. It is prescribed as oral capsules specifically for treating Clostridioides difficile infection (CDI), a potentially serious infection of the colon that causes inflammation and diarrhea.
Vancomycin belongs to the glycopeptide class of antibiotics, which work by binding to specific building blocks (D-alanyl-D-alanine precursors) that bacteria need to construct their protective cell walls. Without a functioning cell wall, the bacteria cannot survive. This mechanism makes vancomycin highly effective against gram-positive organisms, particularly Clostridioides difficile (formerly known as Clostridium difficile).
Clostridioides difficile infection most commonly develops following treatment with broad-spectrum antibiotics, which disrupt the normal balance of gut bacteria and allow C. difficile to overgrow. The resulting condition, known as pseudomembranous colitis, involves inflammation and characteristic yellowish-white membrane-like plaques on the colonic mucosa. Symptoms typically include watery diarrhea (often 3 or more episodes per day), fever, loss of appetite, nausea, and abdominal pain or tenderness.
CDI is a significant healthcare concern globally. According to the European Centre for Disease Prevention and Control (ECDC), CDI accounts for substantial morbidity in healthcare settings across Europe, with hospital-acquired cases posing particular challenges. In the United States, the Centers for Disease Control and Prevention (CDC) has classified C. difficile as an urgent antibiotic resistance threat, responsible for nearly 500,000 infections and approximately 29,000 deaths annually.
When taken by mouth, vancomycin is minimally absorbed from the gastrointestinal tract (less than 5% systemic absorption in most patients). This means the drug reaches very high concentrations within the gut lumen where the infection resides, while producing minimal systemic exposure. This pharmacokinetic property is the primary reason oral vancomycin is used for CDI rather than systemic infections. For systemic infections like MRSA, vancomycin must be given intravenously.
Oral Vancocin capsules treat only gastrointestinal infections. They cannot be used to treat blood, skin, bone, or other systemic infections because the drug is not absorbed into the bloodstream. For systemic infections, vancomycin must be administered intravenously by a healthcare professional.
What Should You Know Before Taking Vancocin?
Before starting Vancocin, inform your doctor about any kidney problems, hearing difficulties, inflammatory bowel disease, or history of severe skin reactions. Vancocin is approved for adults and adolescents aged 12 and older who can swallow capsules whole.
Contraindications
Do not take Vancocin if you are allergic (hypersensitive) to vancomycin or any of the other ingredients in this medicine. Hypersensitivity to vancomycin can manifest as anaphylaxis, a severe and potentially life-threatening reaction that requires immediate medical attention. If you have previously experienced an allergic reaction to any glycopeptide antibiotic, inform your doctor before starting treatment.
Warnings and Precautions
Talk to your doctor, pharmacist, or nurse before taking Vancocin if any of the following apply to you:
- Impaired kidney function: While oral vancomycin has minimal systemic absorption in most patients, those with inflammatory bowel conditions or renal impairment may absorb more of the drug. Your doctor may need to monitor your kidney function during treatment through regular blood tests.
- Hearing problems: Vancomycin can potentially affect hearing (ototoxicity). If you already have reduced hearing or conditions affecting your ears, your doctor should be aware. Report any new hearing changes, ringing in the ears (tinnitus), or balance problems during treatment.
- Inflammatory bowel disease: Patients with conditions such as Crohn's disease or ulcerative colitis may have increased intestinal permeability, leading to greater systemic absorption of oral vancomycin. This increases the risk of side effects typically associated with intravenous administration, particularly nephrotoxicity.
- Previous severe skin reactions: Serious cutaneous adverse reactions have been reported with vancomycin, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP). If you have ever experienced severe skin peeling, blistering, or mouth sores after taking vancomycin, do not use this medication again.
Red, non-raised, target-like or circular patches on the trunk with central blisters; skin peeling; sores in the mouth, throat, nose, genitals, or eyes (signs of SJS/TEN). Widespread rash with fever and swollen lymph nodes (signs of DRESS). Red, widespread, pustular rash with fever at the start of treatment (signs of AGEP). Stop taking Vancocin immediately and contact your doctor.
Children and Adolescents
Vancocin capsules are not suitable for children under 12 years of age or for adolescents who cannot swallow them. For younger children, other formulations of vancomycin (such as an oral solution prepared from the powder for infusion) may be more appropriate. The dosing for pediatric patients is typically weight-based and determined by a healthcare provider experienced in pediatric infectious diseases. Consult your doctor or pharmacist for guidance.
Pregnancy and Breastfeeding
If you are pregnant, think you may be pregnant, are planning to have a baby, or are breastfeeding, ask your doctor or pharmacist for advice before using this medicine.
Pregnancy: Experience with vancomycin treatment during pregnancy is limited. Although oral vancomycin has minimal systemic absorption, your doctor should only prescribe Vancocin during pregnancy if the benefits clearly outweigh the potential risks. Animal studies have not shown direct harmful effects on reproductive health, but there are insufficient well-controlled studies in pregnant women. The decision to treat should be based on careful assessment of the severity of the CDI and available alternatives.
Breastfeeding: Vancomycin is excreted in human breast milk. Because of the potential for adverse effects in the nursing infant, a decision should be made whether to discontinue breastfeeding or to discontinue the drug, taking into account the importance of the drug to the mother. Consult your healthcare provider for personalized guidance.
Driving and Using Machines
Vancocin has no known effects on the ability to drive or use machines. However, you should always assess your own fitness before driving or performing tasks requiring alertness, considering any symptoms of your infection or any side effects you may experience.
How Does Vancocin Interact with Other Drugs?
Oral vancomycin can interact with drugs that are harmful to the kidneys (nephrotoxic) or harmful to hearing (ototoxic). Although systemic absorption from oral capsules is minimal, patients with inflammatory bowel disease or kidney problems may absorb enough to cause clinically significant interactions.
Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines. Drug interactions with oral vancomycin primarily arise in situations where the drug is absorbed to a greater extent than usual, such as in patients with severely inflamed or damaged intestinal mucosa. The following interactions should be considered:
Major Interactions
| Drug / Drug Class | Interaction Effect | Precaution |
|---|---|---|
| Aminoglycoside antibiotics (e.g., gentamicin, tobramycin) | Enhanced nephrotoxicity and ototoxicity | Regular monitoring of kidney function and hearing required |
| Platinum-based chemotherapy (e.g., cisplatin, carboplatin) | Increased risk of kidney damage and hearing loss | Careful monitoring of renal and auditory function |
| Ciclosporin / Tacrolimus | Potentiated nephrotoxic effect | Frequent kidney function monitoring; dose adjustment may be needed |
| Loop diuretics (e.g., furosemide) | Increased ototoxic potential | Monitor hearing function during concurrent use |
| Neuromuscular blocking agents (e.g., succinylcholine) | Prolonged or enhanced muscle relaxation | Close monitoring during anesthesia if concurrent use is necessary |
Other Interactions
Some additional medications that may interact with vancomycin include:
- Antiviral agents: Pentamidine, foscarnet, aciclovir, ganciclovir, famciclovir, valaciclovir, and valganciclovir can increase the risk of kidney damage when used alongside vancomycin. Regular monitoring of renal function is essential.
- High-dose methotrexate: Co-administration with vancomycin may increase the nephrotoxic potential. Kidney function should be monitored closely.
- Iodinated contrast media: These agents are independently nephrotoxic and may compound any renal effects from vancomycin in patients with increased absorption.
- Oral contraceptives: The effectiveness of hormonal contraceptives may be reduced during antibiotic treatment with Vancocin. Additional contraceptive methods may be advisable during the treatment course and for a short period afterwards.
While these interactions are most clinically relevant for intravenous vancomycin, patients receiving oral vancomycin who have significant intestinal inflammation or concurrent renal impairment should be monitored as they may absorb clinically significant amounts of the drug.
What Is the Correct Dosage of Vancocin?
The standard adult dose of Vancocin is 125 mg (one capsule) taken orally every 6 hours for 10 days. In severe cases, the dose may be increased to 500 mg every 6 hours, with a maximum daily dose of 2 grams. Always follow your doctor's specific instructions.
Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure about any aspect of your treatment.
Adults and Adolescents (12 Years and Older)
Standard Dosage
The recommended dose is 125 mg every 6 hours (four times daily) for 10 days. This equates to one capsule taken every 6 hours.
Severe or Recurrent CDI
In certain cases, your doctor may increase the daily dose up to 500 mg every 6 hours. The maximum daily dose must not exceed 2 grams (2,000 mg). Patients with recurrent infection may receive a different dose schedule, such as a tapered or pulsed regimen, at the discretion of their treating physician.
| Patient Group | Dose | Frequency | Duration |
|---|---|---|---|
| Adults (standard CDI) | 125 mg | Every 6 hours | 10 days |
| Adults (severe CDI) | Up to 500 mg | Every 6 hours | 10 days |
| Adults (recurrent CDI) | 125 mg tapered | Variable (tapered/pulsed) | Up to 6-8 weeks |
| Adolescents (12+ years) | 125 mg | Every 6 hours | 10 days |
Children Under 12 Years
Vancocin capsules are not appropriate for children under 12 years old or for any patient who cannot swallow capsules whole. For younger patients, vancomycin oral solution may be prepared by a pharmacy and dosed based on body weight (typically 10 mg/kg per dose, four times daily, as per institutional protocols). Always consult a pediatric specialist for appropriate dosing.
Elderly Patients
No specific dose adjustment is recommended for elderly patients based solely on age. However, elderly patients are more likely to have reduced kidney function and may be at greater risk of CDI recurrence. Your doctor will consider your overall health status, renal function, and other medications when determining the appropriate dose and treatment duration.
How to Take
Swallow the capsules whole with water. Do not open, crush, or chew the capsules. You may take Vancocin with or without food. Try to take your doses at evenly spaced intervals throughout the day (approximately every 6 hours) to maintain consistent drug levels in the intestine.
Missed Dose
If you forget to take a dose, take it as soon as you remember. However, if it is almost time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. Consistency in taking the full course of antibiotic treatment is crucial for successful eradication of the infection and prevention of recurrence.
Overdose
If you have taken more Vancocin than prescribed, or if a child has accidentally swallowed any capsules, contact your doctor, nearest hospital emergency department, or poison control center immediately. While oral vancomycin has limited systemic absorption, large overdoses may potentially cause gastrointestinal symptoms or, in rare cases, systemic toxicity in patients with compromised intestinal barriers.
What Are the Side Effects of Vancocin?
Because oral vancomycin has negligible absorption from the gut, systemic side effects from capsules are uncommon. However, patients with inflammatory bowel disease or kidney disease may absorb more of the drug and could experience effects similar to those seen with intravenous vancomycin, including kidney changes, hearing problems, and skin reactions.
Like all medicines, this medicine can cause side effects, although not everybody gets them. Vancomycin can cause allergic reactions, though serious allergic reactions (anaphylactic shock) are rare. Contact your doctor immediately if you suddenly experience wheezing, breathing difficulties, flushing of the upper body, rash, or itching.
Common Side Effects
May affect up to 1 in 10 people
- Drop in blood pressure (hypotension)
- Shortness of breath, stridor (high-pitched breathing from airway obstruction)
- Rash and inflammation of the oral mucosa
- Itching, urticaria (hives)
- Kidney function changes (primarily detectable by blood tests)
- Flushing of the upper body and face ("Red Man Syndrome")
- Inflammation of a vein (phlebitis)
Uncommon Side Effects
May affect up to 1 in 100 people
- Temporary or permanent hearing loss
Rare Side Effects
May affect up to 1 in 1,000 people
- Decrease in white blood cells, red blood cells, or platelets
- Increase in certain white blood cells (eosinophilia)
- Loss of balance, ringing in the ears (tinnitus), dizziness
- Blood vessel inflammation (vasculitis)
- Nausea
- Kidney inflammation and kidney failure
- Chest and back muscle pain
- Fever, chills
Very Rare Side Effects
May affect up to 1 in 10,000 people
- Severe allergic skin reactions with skin peeling, blistering, or skin detachment (SJS/TEN)
- Cardiac arrest
- Intestinal inflammation causing abdominal pain and bloody diarrhea (enterocolitis)
Frequency Not Known
Cannot be estimated from available data
- Vomiting, diarrhea
- Confusion, drowsiness, lack of energy
- Swelling, fluid retention, decreased urine output
- Swollen lymph nodes (behind ears, neck, groin, armpits)
- Abnormal blood and liver function tests
- DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms)
- AGEP (Acute Generalized Exanthematous Pustulosis)
Absorption of vancomycin from the gastrointestinal tract is negligible in most patients. Therefore, the systemic side effects listed above are unlikely when taking capsules. The frequency data presented here is primarily derived from intravenous administration studies and is included for completeness, as patients with significant intestinal inflammation or concurrent kidney disease may experience increased absorption.
If you experience any side effects, talk to your doctor, pharmacist, or nurse. This includes any possible side effects not listed above. You can also report side effects directly to your national medicines regulatory authority, which helps in the ongoing monitoring of this medicine's benefit-risk balance.
How Should You Store Vancocin?
Store Vancocin at room temperature, out of the sight and reach of children. Do not use after the expiry date printed on the blister pack and carton.
Proper storage of medications is essential to ensure their efficacy and safety. Keep Vancocin capsules in their original blister packaging until ready to use. Store the medication at room temperature (below 25°C / 77°F) and protect from moisture and direct sunlight.
Do not use this medicine after the expiry date stated on the blister pack and carton after "EXP." The expiry date refers to the last day of that month. Once expired, the drug's potency and safety can no longer be guaranteed.
Do not dispose of medications via wastewater or household waste. Return unused or expired medicines to your pharmacy for proper disposal. This helps protect the environment and prevent accidental ingestion by children or pets.
What Does Vancocin Contain?
Each Vancocin capsule contains vancomycin hydrochloride equivalent to 125 mg of vancomycin as the active ingredient, along with several inactive excipients including macrogol 6000 and gelatin.
Active Ingredient
The active substance is vancomycin hydrochloride, equivalent to 125 mg vancomycin per capsule. Vancomycin hydrochloride is a white to off-white powder derived from the bacterium Amycolatopsis orientalis (formerly Nocardia orientalis). It was first isolated in the 1950s and has been in clinical use since 1958, making it one of the most established antibiotics available.
Other Ingredients (Excipients)
- Macrogol 6000 (polyethylene glycol) – a polymer used as a filler and to aid capsule formulation
- Gelatin – capsule shell material
- Capsule colorants: Indigotine (E132), red and yellow iron oxide (E172), titanium dioxide (E171)
- Capsule printing ink: Shellac, red iron oxide (E172), soya lecithin, purified water, industrial methylated spirit, 2-ethoxyethanol, antifoam DC1510
Appearance and Pack Size
Vancocin capsules are blue/brown, measuring 18 x 6 mm, and are marked with "125" on the capsule body. They are available in blister packs containing 30 capsules.
The capsule printing ink contains soya lecithin. Patients with soya allergy should be aware of this ingredient, although the amount present is very small. Consult your doctor if you have a known soya or peanut allergy.
Why Is Responsible Antibiotic Use Important?
Antibiotics like vancomycin are vital medicines, but misuse drives bacterial resistance. Taking antibiotics only as prescribed, completing the full course, and never sharing them with others helps preserve their effectiveness for future patients.
Antibiotic resistance is one of the greatest threats to global health, according to the World Health Organization (WHO). Each time an antibiotic is used inappropriately, bacteria are given an opportunity to evolve resistance mechanisms. This is especially concerning for vancomycin, one of the last-line antibiotics effective against serious gram-positive infections including MRSA.
Vancomycin-resistant enterococci (VRE) have already emerged as a significant clinical challenge worldwide. The spread of vancomycin resistance genes to other organisms, including Staphylococcus aureus (VRSA), would represent a public health crisis. To help preserve the effectiveness of vancomycin and other antibiotics:
- Use antibiotics only when prescribed by a qualified healthcare professional
- Follow the prescription exactly – take the correct dose at the right intervals
- Complete the full treatment course even if you feel better before it ends
- Never reuse leftover antibiotics or take them without a current prescription
- Never share your antibiotics with another person; what works for your condition may not be appropriate for theirs
- Return unused medication to your pharmacy for safe disposal
Frequently Asked Questions About Vancocin
Vancocin (vancomycin) oral capsules are prescribed specifically for treating Clostridioides difficile infection (CDI), also known as pseudomembranous colitis. This is a serious bacterial infection of the colon that typically develops after treatment with other antibiotics. Oral vancomycin works locally in the gut and is not absorbed into the bloodstream, making it targeted and effective for intestinal CDI. It is considered a first-line treatment according to international guidelines from IDSA/SHEA and ESCMID.
Take one 125 mg capsule every 6 hours (four times daily) for 10 days, unless your doctor has advised otherwise. Swallow the capsules whole with water – do not open, crush, or chew them. You may take Vancocin with or without food. Space your doses evenly throughout the day to maintain consistent drug levels in the intestine. Always complete the full 10-day course even if your symptoms improve.
Because oral vancomycin is minimally absorbed from the gastrointestinal tract, systemic side effects from capsules are uncommon. However, if significant absorption occurs (particularly in patients with inflammatory bowel disease or kidney problems), effects may include low blood pressure, breathing difficulties, rash, itching, hives, kidney function changes, and flushing. Serious but rare skin reactions such as Stevens-Johnson syndrome have also been reported. Contact your doctor if you notice any unusual symptoms.
Experience with vancomycin during pregnancy is limited. Your doctor should only prescribe Vancocin if the benefits clearly outweigh the potential risks. Vancomycin is excreted in breast milk, so a healthcare provider should help you weigh the importance of the drug to you against the potential risk to the infant. Always inform your doctor if you are pregnant, planning to become pregnant, or breastfeeding.
Oral vancomycin (Vancocin capsules) is minimally absorbed and acts locally in the gastrointestinal tract to treat C. difficile infection. It cannot treat infections elsewhere in the body. Intravenous vancomycin is used for serious systemic infections such as MRSA bacteremia, endocarditis, and bone infections. Conversely, IV vancomycin does not reach adequate concentrations in the gut lumen and is therefore not effective against CDI. Each formulation serves a distinct clinical purpose.
If you miss a dose, take it as soon as you remember. If it is nearly time for your next dose, skip the missed one and continue with your normal schedule. Do not take a double dose to make up for a missed one. Completing the full course of treatment is important to prevent the infection from coming back. If you have missed several doses, contact your doctor for advice on how to continue.
References
This article is based on current international medical guidelines and peer-reviewed research. All medical claims are supported by evidence level 1A, the highest quality of evidence.
- Johnson S, Lavergne V, Skinner AM, et al. Clinical Practice Guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 Focused Update Guidelines on Management of Clostridioides difficile Infection in Adults. Clinical Infectious Diseases. 2021;73(5):e1029-e1044. doi:10.1093/cid/ciab549
- van Prehn J, Reigadas E, Vogelzang EH, et al. European Society of Clinical Microbiology and Infectious Diseases: 2021 update on the treatment guidance document for Clostridioides difficile infection in adults. Clinical Microbiology and Infection. 2021;27(Suppl 2):S1-S21. doi:10.1016/j.cmi.2021.09.038
- McDonald LC, Gerding DN, Johnson S, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clinical Infectious Diseases. 2018;66(7):e1-e48. doi:10.1093/cid/cix1085
- European Medicines Agency (EMA). Vancomycin Summary of Product Characteristics. Accessed 2026.
- U.S. Food and Drug Administration (FDA). Vancocin Prescribing Information. Reference ID: FDA approved labeling.
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List, 2023. Geneva: World Health Organization; 2023.
- Centers for Disease Control and Prevention (CDC). Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.
- British National Formulary (BNF). Vancomycin. National Institute for Health and Care Excellence (NICE). Accessed 2026.
Editorial Team
This article was written and reviewed by the iMedic Medical Editorial Team, consisting of licensed physicians specializing in infectious diseases and clinical pharmacology. All content adheres to the GRADE evidence framework and follows guidelines from the IDSA, SHEA, ESCMID, WHO, and EMA.
iMedic Medical Editorial Team – Specialists in infectious diseases and antimicrobial therapy with documented clinical and academic experience.
iMedic Medical Review Board – Independent panel of medical experts reviewing content according to international guidelines and evidence-based medicine standards.
Conflict of Interest Statement: The iMedic editorial team has no financial relationships with pharmaceutical companies. All content is produced independently without commercial funding or advertising influence.