Vancomycin
Детермінований перегляд YAML-сутності з джерельної бази. Клінічний авторитет лишається за вказаними source ID та статусом клінічного sign-off.
| ID | DRUG-VANCOMYCIN |
|---|---|
| Тип | Препарат |
| Синоніми | EdicinVancocinVancosanВанкоміцин |
| Статус | переглянуто 2026-04-27 | очікує клінічного підпису |
| Хвороби | Не вказано |
| Джерела | SRC-NCCN-BCELL-2025 SRC-NCCN-MM-2025 |
Дані про препарат
| Клас | Glycopeptide antibiotic (Gram-positive only; MRSA / ampicillin-resistant enterococci) |
|---|---|
| Механізм дії | Branched tricyclic glycopeptide that binds the D-alanyl-D-alanine terminus of pentapeptide cell-wall precursors, sterically blocking transpeptidation and transglycosylation steps in bacterial cell- wall synthesis. Bactericidal against most Gram-positive cocci and bacilli including methicillin-resistant Staphylococcus aureus (MRSA), coagulase-negative staphylococci (most), ampicillin- resistant enterococci (Enterococcus faecium and faecalis except VRE), Streptococcus pneumoniae (including penicillin-resistant), and most anaerobic Gram-positives (Clostridioides difficile via oral route). No Gram-negative activity. FDA-approved 1958. In febrile neutropenia (FN), added to pip-tazo / cefepime / meropenem when MRSA is suspected (catheter-related infection, skin/soft-tissue source, prior MRSA colonization, hemodynamic instability, pneumonia with cavitation, severe mucositis with Gram-positive... |
| Типове дозування | Adult IV (severe Gram-positive infection / FN add-on): loading dose 25-30 mg/kg IV (max 3 g) over ≥1 hour for severe sepsis / endocarditis, followed by maintenance 15-20 mg/kg IV every 8-12 hours adjusted to AUC24/MIC 400-600 mg·h/L (preferred per IDSA 2020) or trough 15-20 mg/L for serious MRSA infections. Pediatric: 15 mg/kg IV q6h. Renal adjustment essential — use Bayesian AUC monitoring or dose- individualization software (CrCl <50 → reduce frequency, e.g., q24h or q48h depending on CrCl); hemodialysis → variable; CRRT → continuous infusion 25-35 mg/kg/day. Hepatic: no adjustment. Duration: per source/syndrome; FN add-on continued ≥48-72 h; if no MRSA isolated and no clear Gram-positive... |
| Зареєстровано в Україні | True |
| Відшкодовується НСЗУ | True |
| Остання перевірка для України | 2026-04-27 |
Нотатки
Empirical vancomycin add-on to FN regimen indicated for: clinically evident catheter-site or tunnel infection, skin/soft-tissue infection, pneumonia with cavitation, hemodynamic instability, severe mucositis with high Gram-positive bacteremia risk, prior MRSA colonization, blood culture preliminary Gram-positive cocci. Discontinue at 48-72 h if cultures negative and no clinical Gram-positive source per stewardship. AUC-guided dosing (target AUC24 400-600 mg·h/L) preferred over trough-based dosing per IDSA 2020 — Bayesian software improves both efficacy (deeper MRSA killing) and safety (lower AKI rate). KEY pitfalls: 'red man syndrome' from rapid infusion is NOT allergy — slow infusion fixes it; conversely, true anaphylaxis is rare but distinct (urticaria, hypotension, bronchospasm). Combination with pip-tazo has a debated AKI signal in adults — substitute cefepime if patient at high renal risk (elderly, baseline CKD, contrast exposure, HSCT). Oral vancomycin only for CDI — no systemic absorption. Ukraine: widely available, NSZU-covered.
Де використовується
У YAML-корпусі не знайдено зворотних посилань.