Renal- renal failure (rare). Intestitial failure (rare) in patients who were given aminogluycosides conconittantly or who had preexisting kidney dysfunction.

Special senses- hearing loss (most patients had kidney dysfunction) vertigo, tinnitus (rare) Hematologic- neutropenia,(promptly reversible on when drug is discontinued), thrombocytopenia (rare)

Miscellaneous- anaphylaxis, drug fever, nausea, chills, eosinophilia, rashes(including exfoliative dermatitis) Stevens -Johnson syndrome )infrequent) Parentral- hypotension, wheezing, dyspnea, urticaria, pruritus, inflammation at the site of injection. Redneck or Red Man syndrome

Hypersens to the drug.

Special precautions:

Administer by slow i.v.only.Monitor auditory and renal function. Redman or redneck syndrome characterised by sudden and profound fall in BP reported. This reaction is stimulated by too rapid infusion.Prolonged therapy may result in over-growth of non-susceptible organisms.

Monitoring- Perform serial tests of auditory function and monitor serum levels Systemicabsorption- clinically significant serum concentrations may occur in some patients with inflammatory disorders of the instinal mucosa. Risk greater with the presence of renal impairment.

Route of administration- For IV use only

Red Man (or Redneck )syndrome- characterized by a sudden and profound fall in blood pressure with or without a maculopapular rash over the face, neck, upper chest, and extremities. The reaction is stimulated by too rapid IVinfusion (dose given over a few minutes)

Monitor blood pressure throughout the infusion, if treatmentis necesary fluids, antihistamines, or corticosteroids may be beneficial

Superinfection- Use of antibiotics (especially prolonged therapy) may result in overgrowth of non-susceptible organisms.Such overgrowth may lead to secondary infection. Take appropiate steps if superinfection occurs.

Warnings-

Ototoxicity - has occured inpatients receiving vancomycin. It may be transcient or permanent. Serial testsof auditory functon may be helpful.

Hypotension- Rapid bolus administration( over several minutes) may be associated with exaggerated hypotension, including shock, and rarely cardiac arrest. To avoid hypotension, administer in a dilute solution over not less than 60 minutes.

Pseudomembranous colitis- in rare caes psuedomembranous colitis has occurred

Reversible neutropenia- occurred in patients receiving vancomycin. Periodically monitor the leukocyte count in patients on prolonged therapy, or those receiving concomittant drugs that may cause neutropenia.

Tissue irritation- vancomycin is irritating to tissue and must be given by a secrte IV route of administration. Renal function impairment- use carefully in renal insufficiency.

Elderly- Adjust dosage schedule in elderly patients

Pregnancy- Give to a pregnant woman only if needed.

Lactation- Excrcise caution when admninstering the drug to a nursing woman

Children- in premature and full term neonates it may be appropiate to confirm desired vancomycin serum concentrations

New Drugs Approved by (DCI) Drug Controller  GENERAL -  India  For Marketing                                                                                            (Ref- IDMA Publication)

Indications:

Serious infections not treatable with other antimicrobials.

Oral - Adults- 500 mg to 2 g/day given in 3 or 4 divided doses for 7 to 10 days, alternatively dosages of 125 mg 3 to 4 times daily may be as effective as 500 mg dose regimen.

Children- 40 mg/kg/day in 3 or 4 divided doses for 7 to 10days .Do not exceed 2g/day.

Missed dose-

1. If you miss a dose of this medicine, take it as soon as possible.

2. However, if it is almost time for next dose, skip the missed dose and go back to your regular dosing schedule.

3. Do not double doses.

Complete full course of therapy, do not discontinue therapy without notifying physician.

1. Allergies- tell your doctor if you have ever had any unusual or allergic reaction to vancomycin. Also tell your doctor if you are allergic to any other substances, such as foods, presevatives or dyes.

2.Pregnancy- studies with oral vancomycin have not been done in eiher humans or animals.

3.Breast feeding- vancomycin passes into the breast milk. However whentaken by mouth only small amounts of vancomycin are absorbed into mothers body

4.Children- no specific information comparing use of oral vancomycin in children with use in other age groups. This medicine is not expected to cause different side efects in children than it does in adults.

5. Elderly- this medicine is not expected to cause different side effects in older people than it does in younger adults.

6. Other medicines - Tell your doctor if you taking Cholestyramine or Colestipol - use of these medicines with oral vancomycin may decrese the effects of oral vancomycin.

7. Other medical problems - Kidney disease or Other inflammatory bowel disorders - patients with these medical problems may have an increased chance of side effects.

8. Missed dose - If you miss a dose of this medicine, take it as soon as possible. however, if it is almost time for the next dose, skip the missed dose. Do not double doses.

9. Storage - Keep out of reach of children. Store away from heat or direct sunlight. Do not store the capsule in bathroom, near the kitchen sink, or in other damp places.

10. Outdated medicines - Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of reach of children.

Pharmacology-

Vancomycinis tricyclic glycopeptide antibiotic whic inhibits cell wall biosynthesis. It also alters bacterial-cell-membrane permeability and RNA synthesis.

Pharmacokinetics-

systemic absorption of oral vancomycin is genearlly poor although clinically significant serum concentrations have occured in patients with active C difficle-induced colitis. In the first 24 hours about 75% of a dose is excreted in urine by glomular fitration

Reports Not available

Pregnancy- Give to a pregnant woman only if needed. Lactation- Excrcise caurtin whennadmninstering the drug to a nursing woman

Children- In premature and full term neonates it may be appropiate to confirm desired vancomycin serum concentrations