Anti-infective Agents : Miscellaneous antibacterials
IUVAN1 “U-Vanco injection” 500mg/vial.
適應症：葡萄球菌感染所導致之心內膜炎、骨髓炎、肺炎、敗血病、軟組織感染、腸炎、梭狀桿菌感染所導致之偽膜性結腸炎。
Usual dose:
Adult:target trough concentration: above 10 mg/L; up to 15 to 20 mg/L for complicated infection (endocarditis, osteomyelitis, meningitis, and hospital-acquired pneumonia) caused by Staphylococcus aureus.
Pediatric:
Neonates (first week of life): Initial dose 15 mg/kg followed by 10 mg/kg/dose every 12 hours.
Neonates (2 to 4 weeks of life): 10 mg/kg/dose every 8 hours.
Preterm infants: 15 to 45 mg/kg/day at intervals of every 6 to 36 hours; dose dependent on age and weight; frequently monitor serum concentrations and serum creatinine with longer than 3 days continuous therapy.
Infants (older than 30 days) and children: 40 mg/kg/day divided every 6 hours.
Dose adjustment:
Renal impairment (adult and pediatric): 15 mg/kg initially and then optimize dose and interval based on serum drug concentrations.
Hemodialysis: Less than 70 kg, 1000-mg loading dose and then 500-mg maintenance dose infused over last 30 minutes of dialysis; 70 to 100 kg, 1250-mg loading dose and then 750-mg maintenance dose infused over last 60 minutes of dialysis; greater than 100 kg, 1500-mg loading dose and then 1000-mg maintenance dose infused over last 90 minutes of dialysis. Obesity: Use actual body weight to calculate initial dose; base adjustments on serum concentration. Anephric patient: Initially 15 mg/kg of body weight; dosage required to maintain stable concentrations is 1.9 mg/kg/24 hours. Anuric patient (adult): 1 g every 7 to 10 days. Neutropenia: A 33% dose increase may be required to achieve therapeutic drug concentrations.
Precaution:
Elderly: monitoring recommended with oral therapy and dose adjustments recommended with IV administration.
Hematologic, Gastrointestinal, Infusion Reactions: Infusion-related reactions, including hypotension and cardiac arrest, may occur; administer in dilute solution over at least 60 minutes and stop infusion if reaction occurs, Transient or permanent ototoxicity may occur especially with excessive IV doses, underlying hearing loss, or concomitant use with ototoxic agents such as aminoglycosides; monitoring recommended.
Renal: Nephrotoxicity, including renal failure, renal impairment, and increased blood creatinine, has been reported; increased risk with underlying renal impairment or concomitant use with aminoglycosides; monitoring recommended.
Adverse effect:
Common: fever
Serious: ototoxicity, nephrotoxicity (oral, 5% ), anaphylaxis, drug hypersensitivity syndrome.
健保使用規範：1.對其他抗生素有抗藥性之革蘭氏陽性菌感染；2.病患對其他抗生素有嚴重過敏反應之革蘭氏陽性菌感染；3.治療抗生素引起之腸炎(antibiotics-associated colitis)，經使用metronidazole無效者始可使用口服vancomycin；4.vancomycin 10 gm（溶液用粉劑）限骨髓移植病例使用；5.其他經感染症專科醫師認定需使用者。（88/3/1）