Vancomycin hameln
Vancomycin – Glycopeptide Antibiotic for Serious Gram-Positive Infections
Quick Facts About Vancomycin hameln
Key Takeaways About Vancomycin hameln
- Reserved for serious infections: Vancomycin is a last-resort antibiotic primarily used for MRSA and other resistant Gram-positive infections, as well as oral treatment of C. difficile colitis
- Must be infused slowly: Intravenous vancomycin must be given over at least 60 minutes to prevent Red Man Syndrome (flushing, hypotension, rash)
- Requires blood monitoring: Therapeutic drug monitoring (TDM) with trough levels or AUC-guided dosing is essential to ensure efficacy and prevent kidney or hearing damage
- Kidney function matters: Dose adjustments are critical in patients with impaired renal function, the elderly, neonates, and those on dialysis
- Oral use is limited: Oral vancomycin is only effective for intestinal C. difficile infection as it is not absorbed systemically from the gut
What Is Vancomycin hameln and What Is It Used For?
Vancomycin hameln contains the active substance vancomycin, a glycopeptide antibiotic that works by killing bacteria that cause serious infections. It is primarily used intravenously for MRSA and other resistant Gram-positive infections, and orally for Clostridioides difficile infection of the intestines.
Vancomycin is one of the most important antibiotics in modern medicine, first discovered in 1953 and introduced into clinical practice in 1958. It belongs to the glycopeptide class of antibiotics, which work by inhibiting bacterial cell wall synthesis. Vancomycin binds to the D-alanyl-D-alanine terminus of cell wall precursor units, preventing the peptidoglycan polymer from forming properly. Without a functional cell wall, susceptible bacteria cannot survive, making vancomycin bactericidal against most Gram-positive organisms.
Vancomycin hameln is available as a powder that is reconstituted and then further diluted before being administered as a slow intravenous infusion. The same reconstituted solution can also be prepared as an oral solution for treating intestinal infections. It is manufactured by hameln pharma gmbh (Germany) and is available in 500 mg and 1000 mg vials.
Approved Indications
Vancomycin hameln is used in all age groups as an intravenous infusion for the treatment of the following serious infections:
- Skin and soft tissue infections – including complicated skin infections caused by MRSA or other susceptible Gram-positive bacteria
- Bone and joint infections – such as osteomyelitis and septic arthritis when caused by susceptible organisms
- Pneumonia – particularly hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) caused by Gram-positive pathogens
- Infective endocarditis – infection of the heart valves, and for prophylaxis of endocarditis in high-risk patients undergoing major surgical procedures
- Bacteraemia (bloodstream infection) – when caused by or suspected to be caused by susceptible Gram-positive organisms
Vancomycin can be given orally to adults and children for the treatment of Clostridioides difficile infection (CDI), formerly known as Clostridium difficile-associated diarrhoea, which causes inflammation and damage to the lining of the large intestine (pseudomembranous colitis). Oral vancomycin is now considered a first-line treatment for CDI according to current Infectious Diseases Society of America (IDSA) and European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines.
Vancomycin is listed on the World Health Organization (WHO) Model List of Essential Medicines and is classified as a "Watch" group antibiotic under the WHO AWaRe classification. This means it should be used judiciously to prevent the emergence of vancomycin-resistant organisms, particularly vancomycin-resistant enterococci (VRE) and vancomycin-intermediate or vancomycin-resistant Staphylococcus aureus (VISA/VRSA).
What Should You Know Before Taking Vancomycin hameln?
Before receiving vancomycin, inform your healthcare provider about any kidney problems, hearing difficulties, or previous allergic reactions to vancomycin or teicoplanin. Vancomycin requires careful monitoring and dose adjustment, particularly in patients with reduced kidney function.
Contraindications
You must not receive Vancomycin hameln if:
- You are allergic to vancomycin or any other component of this medicine
- The medicine is to be given into a muscle (intramuscularly), as this carries a risk of tissue death (necrosis) at the injection site
Severe and potentially life-threatening skin 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). Stop vancomycin and seek immediate medical attention if you develop reddish target-like spots, widespread rash with blisters, skin peeling, or mouth sores.
Serious adverse reactions, including vision loss, have been reported following intravitreal injection (injection into the eye) of vancomycin. Vancomycin is not approved for intravitreal administration.
Warnings and Precautions
Talk to your doctor, pharmacist, or nurse before and during treatment with Vancomycin hameln if any of the following apply to you:
- You have ever had severe skin reactions (skin peeling, blisters, or mouth sores) after taking vancomycin previously
- You have had an allergic reaction to teicoplanin (another glycopeptide antibiotic), as cross-reactivity is possible
- You have a hearing impairment, particularly if you are elderly. Hearing tests may be required during treatment, as vancomycin can cause ototoxicity that may be irreversible
- You have kidney disease or impaired renal function. Regular monitoring of kidney function and blood vancomycin levels is essential
- You are receiving long-term vancomycin therapy. Monitoring of blood counts, liver function, and kidney function is necessary
- You develop severe or prolonged diarrhoea during or after treatment. This could be a sign of antibiotic-associated colitis, which can be life-threatening
Rapid infusion of vancomycin (over less than 60 minutes) can cause a reaction known as Red Man Syndrome or vancomycin infusion reaction. This is characterised by flushing and redness of the upper body and face, itching, and sometimes a drop in blood pressure. This is a histamine-mediated reaction, not a true allergy, and can be managed by slowing the infusion rate and, if needed, pre-treatment with antihistamines.
Use in Children and Neonates
Vancomycin hameln should be used with particular care in premature and full-term neonates because their kidneys are not yet fully developed, which can lead to accumulation of vancomycin in the blood. Blood tests to monitor vancomycin levels are especially important in this age group. Concurrent use of vancomycin with anaesthetic agents has been associated with skin flushing (erythema) and allergic-type reactions in children. Similarly, concomitant use with aminoglycoside antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs such as ibuprofen), or amphotericin B increases the risk of kidney damage, and more frequent blood and kidney monitoring may be necessary.
Pregnancy and Breastfeeding
If you are pregnant or breastfeeding, think you may be pregnant, or are planning to have a baby, ask your doctor or pharmacist for advice before receiving this medicine. Vancomycin crosses the placenta, and while animal studies have not shown direct harm to the foetus, human data is limited. Your doctor will carefully weigh the benefits and risks before deciding whether to administer vancomycin during pregnancy. Vancomycin is excreted in breast milk, and caution should be exercised when administering to breastfeeding women. The low oral bioavailability of vancomycin, however, means that systemic absorption by the nursing infant is expected to be minimal.
Driving and Using Machines
Vancomycin hameln is not expected to affect your ability to drive or operate machinery. However, as dizziness and vertigo are reported side effects, you should assess your own condition before performing tasks that require alertness. If you experience dizziness or balance problems during treatment, avoid driving or operating machinery until these symptoms resolve.
How Does Vancomycin hameln Interact with Other Drugs?
Vancomycin can interact with several drug classes, most importantly aminoglycoside antibiotics, amphotericin B, cisplatin, and loop diuretics, which increase the risk of kidney and hearing damage. General anaesthetics given concurrently can worsen infusion-related reactions.
Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines, including over-the-counter medicines and herbal supplements. Some drug interactions with vancomycin can be clinically significant and may require dose adjustments, additional monitoring, or avoidance of the combination altogether.
Major Interactions
The following medications can significantly increase the risk of adverse effects when used alongside vancomycin:
| Interacting Drug | Risk | Clinical Significance |
|---|---|---|
| Aminoglycosides (gentamicin, tobramycin, amikacin) | Increased nephrotoxicity and ototoxicity | Monitor renal function and drug levels closely; avoid combination if possible |
| Amphotericin B | Increased nephrotoxicity | Requires frequent kidney function monitoring when combined |
| Cisplatin | Increased nephrotoxicity and ototoxicity | Avoid combination when possible; monitor hearing and renal function |
| Piperacillin/tazobactam | Increased risk of acute kidney injury (AKI) | Consider alternative beta-lactam; close renal monitoring if combined |
| General anaesthetics | Increased risk of flushing, hypotension, cardiac arrest | Administer vancomycin before induction; infuse over at least 60 minutes |
| Loop diuretics (furosemide) | Increased ototoxicity | Monitor hearing function; use lowest effective diuretic dose |
Minor Interactions
The following interactions are generally less severe but should still be considered:
- NSAIDs (ibuprofen, diclofenac, naproxen): May increase the risk of nephrotoxicity. Monitor kidney function during concurrent use
- Polymyxins (colistin, polymyxin B): Additive nephrotoxicity risk. Combination requires careful renal monitoring
- Bacitracin: Increased risk of kidney damage when used systemically with vancomycin
- Proton pump inhibitors (PPIs): When vancomycin is given orally for CDI, PPIs may reduce the effectiveness of treatment by altering intestinal pH
- Drugs that reduce intestinal motility: Should be avoided during oral vancomycin treatment for CDI, as they may prolong exposure to C. difficile toxins
If you are scheduled for surgery under general anaesthesia, inform your anaesthetist that you are receiving vancomycin. Concurrent administration of vancomycin and anaesthetic agents can increase the risk of histamine-mediated reactions, including severe flushing, hypotension, and in rare cases cardiac complications. Vancomycin should ideally be administered before anaesthesia induction, with the infusion completed before induction begins.
What Is the Correct Dosage of Vancomycin hameln?
Vancomycin dosage is individualised based on body weight, renal function, age, and the type of infection. For adults receiving IV vancomycin, the standard dose is 15–20 mg/kg every 8–12 hours. Oral vancomycin for C. difficile is typically 125 mg four times daily for 10 days.
Vancomycin hameln is administered by healthcare professionals in a hospital setting. Your doctor will determine the appropriate dose and duration of treatment based on your individual circumstances. Therapeutic drug monitoring (TDM) is an essential part of vancomycin therapy, with current guidelines from IDSA, ASHP, and the Pediatric Infectious Diseases Society recommending AUC-guided dosing (targeting an AUC/MIC ratio of 400–600 mg·h/L) over traditional trough-only monitoring.
Adults and Adolescents (12 Years and Older) – Intravenous
Standard IV Dosing
The dose is calculated based on body weight. The usual infusion dose is 15–20 mg per kg body weight, given every 8 to 12 hours. In certain serious infections (such as endocarditis, meningitis, or bacteraemia), the doctor may decide to give a loading dose of up to 25–30 mg per kg body weight for the first dose. The maximum daily dose should not exceed 2 g unless guided by TDM results.
Adults and Adolescents – Oral (for C. difficile Infection)
Standard Oral Dosing for CDI
The recommended dose is 125 mg every 6 hours for 10 days. In certain severe cases, the doctor may increase the dose up to 500 mg every 6 hours. The maximum daily dose should not exceed 2 g. For recurrent CDI episodes, a different dosing regimen or tapered/pulsed course may be recommended.
Children
| Age Group | Route | Dose | Frequency |
|---|---|---|---|
| Neonates (0–27 days) | IV infusion | Individualised based on postmenstrual age | Determined by physician based on gestational and postnatal age |
| Infants & children (1 month to <12 years) | IV infusion | 10–15 mg/kg | Every 6 hours |
| Adolescents (12–18 years) | IV infusion | 15–20 mg/kg | Every 8–12 hours |
| Children <12 years (CDI) | Oral | 10 mg/kg (max 125 mg/dose) | Every 6 hours for 10 days |
| Adolescents 12–18 years (CDI) | Oral | 125 mg | Every 6 hours for 10 days |
Elderly Patients
Elderly patients often have reduced kidney function, which affects the elimination of vancomycin from the body. Lower initial doses and/or longer dosing intervals may be required. Kidney function should be assessed before starting treatment, and vancomycin blood levels should be monitored closely throughout treatment. The decline in renal function with age means that dose adjustments are almost always necessary in patients over 65 years of age.
Patients with Kidney Disease
Vancomycin is eliminated almost entirely by the kidneys, making dose adjustment essential in patients with renal impairment. In patients with reduced glomerular filtration rate (GFR), the dosing interval must be extended or the dose reduced. Patients on haemodialysis typically receive a dose after each dialysis session, as vancomycin is not efficiently removed by conventional haemodialysis but is partially removed by high-flux membranes. All dose adjustments should be guided by therapeutic drug monitoring.
How Vancomycin Is Administered
Intravenous use: The reconstituted and diluted vancomycin solution is given as a slow intravenous infusion over at least 60 minutes. A faster infusion rate or higher concentration increases the risk of Red Man Syndrome and severe hypotension. Vancomycin must never be given as a rapid intravenous push (bolus) or by intramuscular injection.
Oral use: For the treatment of CDI, vancomycin can be prepared as an oral solution. The contents of the intravenous vials are dissolved in water and taken by mouth. Oral vancomycin acts locally in the gut and is not absorbed into the systemic circulation in significant amounts.
Missed Dose
Since vancomycin is administered in a hospital setting by healthcare professionals, missed doses are unlikely. If a dose is inadvertently missed, it should be given as soon as possible, and the subsequent dosing schedule should be adjusted accordingly based on drug level monitoring. Do not double the dose to make up for a missed one.
Overdose
Since vancomycin is administered in a supervised hospital setting, overdose is uncommon. However, if too much vancomycin is given, symptoms may include worsening of the known side effects, particularly nephrotoxicity and ototoxicity. Treatment is supportive, with monitoring of kidney function and vancomycin blood levels. Haemofiltration or high-flux haemodialysis may help to remove vancomycin from the blood in cases of severe overdose. During treatment, your blood, urine, and possibly hearing may be monitored to detect early signs of toxicity.
What Are the Side Effects of Vancomycin hameln?
Common side effects of vancomycin include flushing and redness of the upper body (Red Man Syndrome from rapid infusion), low blood pressure, breathing difficulties, rash, itching, and kidney problems. Hearing loss, blood count changes, and severe skin reactions are less common but potentially serious.
Like all medicines, Vancomycin hameln can cause side effects, although not everyone gets them. Vancomycin can cause allergic reactions, though severe anaphylactic shock is rare. Tell your doctor immediately if you suddenly develop wheezing, difficulty breathing, flushing of the upper body, rash, or itching.
Reddish, target-like or circular spots on the trunk with blisters in the centre, skin peeling, sores in the mouth, throat, nose, or genital area (signs of SJS/TEN). Widespread rash, high body temperature, and enlarged lymph nodes (DRESS syndrome). Red, scaly, widespread rash with bumps under the skin and blisters accompanied by fever (AGEP).
Common Side Effects
May affect up to 1 in 10 people
- Drop in blood pressure (hypotension)
- Shortness of breath, wheezing (stridor from upper airway obstruction)
- Rash, inflammation of the mouth lining, itching, hives (urticaria)
- Kidney problems (primarily detected through blood tests – elevated creatinine)
- Flushing of the upper body and face (Red Man Syndrome)
- Inflammation of a vein at the infusion site (phlebitis)
Uncommon Side Effects
May affect up to 1 in 100 people
- Temporary or permanent hearing loss (ototoxicity)
Rare Side Effects
May affect up to 1 in 1,000 people
- Decrease in white blood cells, red blood cells, and platelets (pancytopenia)
- Increase in certain white blood cells (eosinophilia)
- Loss of balance, tinnitus (ringing in the ears), dizziness
- Blood vessel inflammation (vasculitis)
- Nausea
- Kidney inflammation (interstitial nephritis) and kidney failure
- Pain in the chest and back muscles
- Fever, chills
Very Rare Side Effects
May affect up to 1 in 10,000 people
- Severe allergic skin reactions (SJS, TEN) – skin peeling, blistering, scaling, possibly with high fever and joint pain
- Cardiac arrest
- Intestinal inflammation (enterocolitis) causing abdominal pain and bloody diarrhoea
Frequency Not Known
Cannot be estimated from available data
- Vomiting, diarrhoea
- Confusion, drowsiness, weakness
- Swelling, fluid retention, decreased urine output
- Rash with swollen lymph nodes, abnormal blood and liver test results (DRESS syndrome)
- Rash with blisters and fever (AGEP)
- Linear IgA bullous dermatosis (blistering skin condition)
When vancomycin is given orally for C. difficile infection, systemic absorption is negligible in most patients. However, in patients with inflammatory bowel disease or significant mucosal damage – especially those who also have kidney disease – systemic side effects similar to those seen with intravenous administration may occur.
If you experience any side effects, talk to your doctor, pharmacist, or nurse. This includes any possible side effects not listed here. You can also report side effects directly to your national medicines regulatory authority. By reporting side effects, you help provide more information on the safety of this medicine.
How Should You Store Vancomycin hameln?
Store Vancomycin hameln vials (unopened powder) at room temperature with no special storage requirements. After reconstitution, the solution is stable for up to 24 hours at room temperature or 96 hours refrigerated (2–8°C). The reconstituted product should be used promptly for microbiological safety.
Keep this medicine out of the sight and reach of children. Do not use this medicine after the expiry date stated on the carton and label after "EXP". The expiry date refers to the last day of that month.
The unopened powder vials of Vancomycin hameln do not require any special storage conditions. They should be stored at room temperature and protected from extreme heat or cold.
Stability After Reconstitution
Once reconstituted, the chemical and physical stability of the concentrate has been demonstrated for:
- Up to 24 hours at room temperature (25°C)
- Up to 96 hours refrigerated at 2–8°C
After further dilution for infusion, the solution is stable for up to 24 hours at room temperature or 96 hours refrigerated, for concentrations of 5–10 mg/mL. However, from a microbiological perspective, the product should be used immediately after preparation. If not used immediately, storage times and conditions before use are the responsibility of the healthcare professional and should normally not exceed 24 hours at 2–8°C unless preparation was carried out under controlled aseptic conditions.
Oral solutions prepared from the reconstituted powder can be stored in the refrigerator (2–8°C) for up to 96 hours.
What Does Vancomycin hameln Contain?
Vancomycin hameln contains vancomycin hydrochloride as its only ingredient. There are no excipients. The 500 mg vial contains vancomycin hydrochloride equivalent to 500 mg vancomycin (500,000 IU), and the 1000 mg vial contains 1000 mg vancomycin (1,000,000 IU).
Active Substance
The active substance is vancomycin (as hydrochloride).
- Vancomycin hameln 500 mg: Each vial contains vancomycin hydrochloride equivalent to 500 mg vancomycin (500,000 IU)
- Vancomycin hameln 1000 mg: Each vial contains vancomycin hydrochloride equivalent to 1000 mg vancomycin (1,000,000 IU)
Other Ingredients
There are no other excipients in this product. The vials contain only vancomycin hydrochloride.
Appearance and Pack Sizes
Vancomycin hameln is an off-white to light beige powder supplied in Type I colourless glass vials with bromobutyl rubber stoppers and aluminium crimp caps. The 500 mg vials have a violet flip-off plastic cap, and the 1000 mg vials have a green flip-off plastic cap. Packs are available containing 1, 5, or 10 vials. Not all pack sizes may be marketed in every country.
Reconstitution and Dilution
For intravenous use, the powder must be reconstituted and then further diluted before administration:
- Reconstitution: Add 10 mL of water for injections to the 500 mg vial (or 20 mL to the 1000 mg vial) to produce a solution of 50 mg/mL
- Further dilution: The reconstituted solution must be further diluted with a compatible infusion fluid (e.g., 0.9% sodium chloride or 5% glucose) before infusion. A 500 mg dose should be diluted in at least 100 mL; a 1000 mg dose in at least 200 mL
- Administration: Infuse over at least 60 minutes
Why Is Responsible Use of Vancomycin Important?
Vancomycin is a critically important antibiotic, and its misuse contributes to the emergence of resistant bacteria such as vancomycin-resistant enterococci (VRE) and VRSA. Responsible antibiotic stewardship – using vancomycin only when prescribed, following the correct dosage, and completing the full course – is essential to preserve its effectiveness.
Antibiotics are used to treat bacterial infections. They have no effect on viral infections such as colds, influenza, or COVID-19. If your doctor has prescribed vancomycin, you need it specifically for your current infection. It should not be reused without a prescription, even if you want to treat a similar illness.
Some bacteria can survive or grow despite antibiotic treatment, a phenomenon known as antimicrobial resistance. The inappropriate use of antibiotics accelerates the development of resistance, which can render antibiotic treatments ineffective. The WHO has identified antimicrobial resistance as one of the top 10 global public health threats, and vancomycin resistance is a particular concern because vancomycin is often one of the last available treatment options for multidrug-resistant Gram-positive infections.
To help preserve the effectiveness of vancomycin:
- Use antibiotics only when prescribed by a healthcare professional
- Follow the prescribed dosage and schedule strictly
- Complete the full course of treatment, even if you feel better
- Never share antibiotics with others or use leftover antibiotics
- Support infection prevention measures such as hand hygiene and vaccination
Vancomycin is classified in the WHO "Watch" group – antibiotics that have higher resistance potential and should be prioritised as key targets for stewardship programmes and monitoring. The Watch group includes antibiotics that are critically important for human medicine and should be prescribed only for specific clinical indications.
Frequently Asked Questions About Vancomycin hameln
Vancomycin is a glycopeptide antibiotic used to treat serious bacterial infections caused by Gram-positive organisms, particularly methicillin-resistant Staphylococcus aureus (MRSA). It is given intravenously for skin and soft tissue infections, bone and joint infections, pneumonia, endocarditis (heart valve infection), and bloodstream infections. It can also be given orally to treat Clostridioides difficile infection (CDI), which causes severe diarrhoea and colitis.
Red Man Syndrome (RMS) is a histamine-mediated infusion reaction that occurs when vancomycin is administered too rapidly. It is characterised by flushing, erythema (redness) of the face, neck, and upper torso, itching, and sometimes a drop in blood pressure. RMS is not a true allergy to vancomycin. It can be effectively prevented by infusing vancomycin slowly over at least 60 minutes and, if necessary, by pre-treating with antihistamines such as diphenhydramine. If RMS occurs, the infusion should be paused, antihistamines given, and the infusion restarted at a slower rate.
Yes, vancomycin requires therapeutic drug monitoring (TDM). Blood levels are measured to ensure the drug is effective against the infection while minimising the risk of kidney damage (nephrotoxicity) and hearing damage (ototoxicity). Current guidelines from IDSA and ASHP recommend AUC-guided dosing, targeting an AUC/MIC ratio of 400–600 mg·h/L. Kidney function tests (serum creatinine), complete blood counts, and sometimes hearing tests should also be performed regularly during treatment, especially for prolonged courses.
Yes, but only for the treatment of Clostridioides difficile infection (CDI) of the intestines. When taken orally, vancomycin is not absorbed into the bloodstream in clinically significant amounts – it remains in the gastrointestinal tract where it acts directly against C. difficile bacteria. For all other types of infections (skin, bone, lung, bloodstream, etc.), vancomycin must be given as an intravenous infusion because it needs to reach therapeutic concentrations in the blood and tissues.
The most serious side effects include nephrotoxicity (kidney damage), which is usually reversible if detected early through blood monitoring; ototoxicity (hearing loss), which can be temporary or permanent; severe allergic reactions including anaphylaxis; and serious skin reactions such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and DRESS syndrome. Very rarely, cardiac arrest has been reported with rapid infusion. Red Man Syndrome, while concerning, is typically manageable by slowing the infusion rate.
The duration of treatment depends on the type and severity of infection. Skin and soft tissue infections are typically treated for 7–14 days. Bone and joint infections (osteomyelitis) may require 4–6 weeks. Infective endocarditis usually requires 4–6 weeks of therapy. For oral treatment of C. difficile infection, the standard course is 10 days, though recurrent infections may need longer or tapered/pulsed regimens. Your doctor will determine the optimal duration based on clinical response and microbiology results.
References
- Rybak MJ, Le J, Lodise TP, et al. Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: A revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists. Am J Health-Syst Pharm. 2020;77(11):835–864. doi:10.1093/ajhp/zxaa036
- 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. Clin Infect Dis. 2021;73(5):e1029–e1044. doi:10.1093/cid/ciab549
- World Health Organization. WHO Model List of Essential Medicines – 23rd List, 2023. Geneva: WHO; 2023.
- European Medicines Agency. Vancomycin – Summary of Product Characteristics. EMA; 2024.
- British National Formulary (BNF). Vancomycin. National Institute for Health and Care Excellence (NICE); 2024.
- van Hal SJ, Paterson DL, Lodise TP. Systematic review and meta-analysis of vancomycin-induced nephrotoxicity associated with dosing schedules that maintain troughs between 15 and 20 mg/L. Antimicrob Agents Chemother. 2013;57(2):734–744.
- Filippone EJ, Kraft WK, Farber JL. The nephrotoxicity of vancomycin. Clin Pharmacol Ther. 2017;102(3):459–469.
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID). Treatment guidance for Clostridioides difficile infection. 2024.
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