Non-β-lactam agents that inhibit cell wall synthesis. They are:

  • Active against gram-positive anaerobes and aerobes
  • Bacteriostatic against enterococci and streptococci
  • Bacteriocidal against staphylococci
Property Vancomycin
Uses MRSA, C. difficile
Presentation Powder for reconstitution
Route of Administration PO, IV, Intrathecal
Dosing Peak levels determined by dose, trough levels by dose and interval
Absorption No oral bioavailability. Poor CSF penetration
Distribution VD 0.4-1 Poor CSF penetration even with inflamed meninges - higher levels are required for CNS penetration. ~50% protein bound.
Metabolism Minimal hepatic metabolism
Elimination 90% secreted unchanged in urine - significantly prolonged in renal impairment
CVS Phlebitis, red man syndrome (profound non-anaphylactic histamine release with rapid injection)
CNS Ototoxicity
Renal Nephrotoxicity, typically temporary and resolves on cessation
Haematological Thrombocytopenia
Immunological 'Red man syndrome' due to histamine release with rapid injection, with accompanying ↑ HR ↓ BP. Neutropenia.
Other Synergistic action with cephalosporins, aminoglycosides, and rifampicin


  1. Peck TE, Hill SA. Pharmacology for Anaesthesia and Intensive Care. 4th Ed. Cambridge University Press. 2014.
  2. Wellington ICU Drug Manual
  3. Rybak MJ. The pharmacokinetic and pharmacodynamic properties of vancomycin. Clin Infect Dis. 2006 Jan 1;42 Suppl 1:S35-9.
Last updated 2019-07-18

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