AlternativeVancocin

Vancomycin

Glycopeptide

MRSA cover in severe maternal sepsis or penicillin-anaphylactic women.

IVOral (C. diff only)

First-line for

MRSA bacteraemia/endometritis
C. difficile colitis (oral)
Penicillin-anaphylactic prophylaxis

Mechanism

Binds D-Ala-D-Ala in cell wall — inhibits transglycosylation. Bactericidal (slow).

“Red man ≠ allergy”

Slow rate to ≥60 min per gram
Pre-treat with antihistamine if reaction
True allergy = rash + bronchospasm

Dosing

IV: 15–20 mg/kg q8–12h; target trough 15–20 mg/L
Oral (C diff): 125 mg QDS x 10 d

Contraindications

CautionRenal impairment — dose by levels

Side effects

Red-man syndrome (histamine, rate-related)
Nephrotoxicity
Ototoxicity

Fetal & maternal notes

• Crosses placenta minimally — safe in pregnancy when indicated

Key interactions

Aminoglycosides
Caution
Additive nephro/ototoxicity
Piperacillin-tazo
Caution
↑ AKI

Clinical pearls

💡 Oral vanc treats C. diff but is NOT systemically absorbed — useless for bacteraemia

Content last reviewed: REPLACE_ME (e.g. 2026-07)

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