3.20 Miscellaneous Antibacterials: Glycopeptides
Vancomycin is a glycopeptide commonly used to treat MRSA.
Mechanism of Action: Glycopeptides are a class of medications that inhibit bacterial cell wall synthesis.
Indications: Vancomycin is a popular glycopeptide that is active against gram-positive bacteria. Vancomycin is commonly used to treat serious or severe infections when other antibiotics are ineffective or contraindicated, including those caused by MRSA and C-diff.
Nursing Considerations: It is poorly absorbed from the GI tract, so it must be given by IV to treat a systemic infection. Oral vancomycin, on the other hand, is used to treat antibiotic-associated Clostridium difficile (C-diff) infection. Vancomycin poses a significant risk to kidney function and hearing; therefore, clients’ trough levels must be monitored carefully for effective IV dosing to avoid complications. Clients receiving IV vancomycin may also experience a complication known as “vancomycin flushing syndrome” in which they experience a flushing of the skin and a reddish rash on the upper body when the infusion is administered too rapidly.
Side Effects/Adverse Effects: Side effects of glycopeptides include nephrotoxicity and ototoxicity. Additionally, C-diff can occur up to two months after the therapy ends. Vancomycin flushing syndrome can occur if the drug is infused too rapidly. Signs and symptoms include maculopapular rash on face, neck, trunk, and limbs and pruritus and hypotension caused by histamine release.
Health Teaching & Health Promotion: Clients should be counseled to take medications as directed for the full course of antibacterial therapy. They should monitor for side effects such as hypersensitivity, tinnitus, hearing loss, and vertigo. Clients should promptly follow up with their health care provider if no improvement in symptoms is identified.[1]
Now let’s take a closer look at the medication grid on vancomycin in Table 3.20.[2]
Table 3.20 Vancomycin Medication Grid
| Class/Subclass | Prototype/Generic | Nursing Considerations | Therapeutic Effects | Side/Adverse Effects |
|---|---|---|---|---|
| Miscellaneous Antibacterials: Glycopeptides |
vancomycin | Check for allergies
Route: IV but for C-diff may be administered PO or rectally as an instilled enema Obtain culture prior to administering first dose Dosage adjustment is required for renal impairment Monitor trough levels IV should be administered in a diluted solution over a period of 60 minutes or more to avoid rapid-infusion-related reactions |
Monitor for systemic signs of infection:
-WBCs -Fever Monitor actual site of infection for improvement Monitor and report trough levels for targeted dosing |
Nephrotoxicity
Ototoxicity C-diff can occur up to two months after therapy ends Vancomycin flushing syndrome can occur if drug is infused too rapidly. Signs and symptoms include maculopapular rash on face, neck, trunk, and limbs and pruritus and hypotension caused by histamine release. Stop infusion and contact provider. Prepare to administer diphenhydramine 50mg IV or PO. Monitor BP closely; IV fluids and/or vasopressors may be required if hypotensive. Infusion may be restarted at a slower rate after rash and itching resolve |
Critical Thinking Activity 3.20
Using the above grid information, consider the following clinical scenario question:
A nurse is caring for a client who was prescribed vancomycin IV for a MRSA infection. The dose of medication is due now, but a trough level is not yet available in the chart. What is the nurse’s next best response?
Note: Answers to the Critical Thinking activities can be found in the “Answer Key” section at the end of the book.
- uCentral from Unbound Medicine. https://www.unboundmedicine.com/ucentral ↵
- This work is a derivative of DailyMed by U.S. National Library of Medicine in the Public Domain. ↵