Vancomycin in Pediatrics

Abstract

Vancomycin, a complex glycopeptide antibiotic, has achieved somewhat limited use since its introduction in 1956. It has excellent antibacterial activity against a variety of Gram-positive organisms, including those resistant to semisynthetic penicillins such as methicillin. Because of its higher potential for adverse side effects, such as thrombophlebitis and ototoxicity, it should be reserved for illnesses associated with methicillin-resistant staphylococci or in patients who have serious allergies to the penicillins. It has shown excellent effectiveness in a wide range of serious infections due to Gram-positive bacteria. Vancomycin should be administered intravenously, except in the case of staphylococcal or pseudomembranous colitis associated with C difficile in which oral administration is the appropriate route. In infections with enterococci, combination with an aminoglycoside is indicated as synergism occurs. It is excreted by the kidney; extra care must be taken in treating patients with renal failure. Dosing in anephric patients undergoing dialysis is greatly simplified by its prolonged half-life and is usually necessary only every seven to 14 days. Monitoring the serum concentration is desirable in all patients receiving vancomycin to ensure an efficacious, but nontoxic level.