Naturally derived antibiotic (glycopeptide) used intravenously against serious infections by gram-positive bacteria, such as MRSA, and orally against Clostridioides difficile diarrhea.
Regulatory status
Approved (FDA / EMA)
Family
Glycopeptide antibiotic
Scientific evidence
Very high
Number of findings
1
Where it acts
Immunity and defense · Digestion and weight
Also known as
vancomycin, Vancocin, Firvanq
Regulatory status
FDA (US): Approved (1958, Vancocin) for serious gram-positive infections; oral for C. difficile diarrhea and staphylococcal enterocolitis
EMA (EU): No centralized authorization; authorized through national procedures in the EU and in Spain (generics)
Dose
C. difficile (oral): 125 mg four times a day for 10 days (FDA label). Intravenous: weight-based dose adjusted to kidney function and blood levels, according to the label and hospital protocol.
Safety
Intravenous: kidney damage (more with high doses or alongside other nephrotoxic drugs), ototoxicity, and a reaction to rapid infusion (flushing, 'red man syndrome'). Requires level monitoring. Use by prescription and under medical supervision.
Interactions
Higher risk of kidney or hearing damage with aminoglycosides, piperacillin-tazobactam, amphotericin B, cyclosporine, or loop diuretics.
Effect by goal · level of evidence
C. difficile diarrhea: high cure rate, but more relapses than fidaxomicin
improvesHighRCT (AA)in people
86% cure
In 629 patients, oral vancomycin cured 85.8% (fidaxomicin 88.2%), but relapse was higher: 25.3% versus 15.4%.
It binds to the building blocks of the bacterial wall (D-Ala-D-Ala) and prevents the bacterium from building it, so the bacterium dies. It acts only on gram-positive bacteria. Taken by mouth it is barely absorbed and acts directly in the intestine.
What the evidence says
In people
C. difficile diarrhea: high cure rate, but more relapses than fidaxomicin. In 629 patients, oral vancomycin cured 85.8% (fidaxomicin 88.2%), but relapse was higher: 25.3% versus 15.4%. PubMed 21288078