Vancomycin dosage, forms, and strengths

Vancomycin hydrochloride (HCl) is a generic glycopeptide antibiotic also known under the brand names Vancocin, Firvanq, and Firvanq Novaplus. Vancomycin HCl can be found as injectable or oral forms. The intravenous version of vancomycin is typically reserved for more serious types of infections. Vancomycin is a popular option for patients who cannot receive or who have failed to respond to other first line drugs including penicillins or cephalosporins. It is a “last resort” antibiotic.

This antibiotic is considered bactericidal as it kills the bacteria it is targeting. Its pharmacokinetics involves blocking cell wall synthesis of gram positive organisms that it is most effective against. Data also shows there is no cross resistance between vancomycin and other antibiotics. 

The oral form of this strong antimicrobial agent is used to treat bacterial diarrhea or bowel infections. Oral vancomycin is only effective in the intestines and cannot treat other bacterial infections within other parts of the body. This is due to the oral form of this antibacterial drug not being well absorbed in other locations when taken by mouth.

Vancomycin forms and strengths

Vancomycin comes in various forms. It can be taken by mouth or given as an injection. Here is some additional drug information regarding vancomycin treatment options:

• Capsule: 125 mg or 250 mg

• Oral solution: 3.75 g, 7.5 g, 10.5 g, 15 g

• Intravenous injection: 500 mg, 750 mg, 1 g, 5 g, 10 g

Vancomycin dosage for adults

Vancomycin HCl IV is used for the treatment of various infections involving the skin, bone, blood, and heart. Oral administration is only effective against gastrointestinal infections, which helps to improve the symptoms of diarrhea and abdominal pain. There are also many off-label treatments for the management of meningitis, anthrax, and urinary tract infections. Here are some traditional indications for the use of vancomycin:

* There are also off-label treatments for other health conditions that are NOT listed above.

Vancomycin dosage for bacterial infections

Vancomycin is approved by the FDA for the treatment of severe bacterial infections from various bacteria such as methicillin-resistant Staphylococcus aureus (MRSA), coagulase negative staphylococci, and methicillin-susceptible staphylococci. Infections involving the soft tissues, bone, lower respiratory tract, and the blood can all be managed with intravenous vancomycin.

• Take 15-20 mg/kg IV every 8-12 hours

• Dosages will be adjusted based on laboratory serum levels

• Max dose: 3 g/dose

Vancomycin dosage for diarrhea

Vancomycin is approved by the FDA for the treatment of diarrhea caused by the bacteria Clostridium difficile. The oral form is used, which includes the brand names Vancocin and Fivanq.

• 1st episode:

  • Mild to moderate infection: Take 125 mg every 6 hours for 10 days

  • Severe infection: Take 500 mg every 6 hours; may take with metronidazole IV

• 2nd episode: Take 125 mg every 6 hours for 10-14 days

  • Then 125 mg every 12 hours for 7 days

  • Then 125 mg once daily for 7 days

  • Then 125 mg every 2-3 days for 2-8 weeks

  • Alternative: Take 125 mg every 6 hours for 10 days if metronidazole IV is given initially

• 3rd or more episodes: Take 125 mg every 6 hours for 10-14 days

  • Then 125 mg every 12 hours for 7 days

  • Then 125 mg once daily for 7 days

  • Then 125 mg every 2-3 days for 2-8 weeks

  • Alternative: Take 125 mg every 6 hours for 10 days then rifaximin for 20 days

Vancomycin dosage for endocarditis

Vancomycin is approved by the FDA for the treatment of endocarditis due to susceptible isolates of MRSA, viridans group streptococci Streptococcus gallolyticus, Enterococcus species, and Corynebacterium species.

• Take 15-20 mg/kg IV every 8-12 hours for at least 4 weeks

• Dosages will be adjusted based on laboratory serum levels

• Max dose: 3 g/dose

• Can be used as a combination therapy with rifampin and an aminoglycoside

Vancomycin dosage for enterocolitis

Vancomycin is approved by the FDA for the treatment of staphylococcal enterocolitis. The oral form is used (Vancocin and Fivanq).

• Take 500-2000 mg per day divided every 6-8 hours per day

• Use for 7-10 days

• Includes treatment of MRSA strains

Vancomycin dosage for pneumonia

Vancomycin is approved by the FDA for the treatment of pneumonia due to susceptible isolates of MRSA and coagulase negative staphylococci in both community acquired and hospital acquired cases.

• Take 15-20 mg/kg IV every 8-12 hours for 7 days

• Dosages will be adjusted based on laboratory serum levels

• Max dose: 3 g/dose

Vancomycin dosage for children

Vancyomycin is approved by the FDA for pediatric patients as young as neonates (younger than 7 days old) for the treatment of septicemia, infective endocarditis, skin and skin structure infections, bone infections, and lower respiratory tract infections. Dosages are typically adjusted based on laboratory serum levels while using Vancomycin.

Vancomycin dosage for bacterial infections in pediatric patients

Vancomycin is approved by the FDA for the treatment of severe bacterial infections from various bacteria such as methicillin-resistant Staphylococcus aureus (MRSA), coagulase negative staphylococci, and methicillin-susceptible staphylococci in pediatric patients and adults. 

• Neonates younger than 7 days old

  • Less than 1.2 kg: Take 15 mg/kg IV every 24 hours

  • 1.2-2 kg: Take 10-15 mg/kg IV every 12-18 hours

  • Greater than 2.1 kg: Take 10-15 mg/kg IV every 8-12 hours

• Neonates older than 7 days old

  • Less than 1.2 kg: Take 15 mg/kg IV every 24 hours

  • 1.2-2 kg: Take 10-15 mg/kg IV every 8-12 hours

  • Greater than 2.1 kg: Take 15-20 mg/kg IV every 8 hours

• 1-3 months of age: Take 10-15 mg/kg IV every 6-8- hours

  • Max dose: 1g IV dose

• 4 months to 11 years of age: Take 60-80 mg/kg IV every 6-8 hours

  • Max dose: 100 mg/kg IV per day

• 12 years and older: 1g IV every 12 hours

  • Max dose: 3 g/dose

Vancomycin dosage for diarrhea in pediatric patients

Vancomycin is approved by the FDA for the treatment of diarrhea caused by the bacteria Clostridium difficile in pediatric patients less than 18 years of age. The oral form is used (Vancocin and Fivanq).

• 1st episode (mild to moderate infection): 

  • Take 40 mg/kg every 6 hours for 10 days

  • Max dosage: 125 mg/dose

  • Used as first line treatment

• 1st episode (severe infection):

  • Take 40 mg/kg every 6 hours for 10 days

  • Max dosage: 500 mg/dose

  • May take with metronidazole IV

• 2nd episode:

  • Take 40 mg/kg every 6 hours for 10 days

  • Max dosage: 125 mg/dose

• 3rd or more episodes:

  • Take 10 mg/kg every 6 hours for 14 days

  • Then 10 mg/kg every 12 hours for 7-14 days

  • Then 10 mg/kg once daily for 7-14 days

  • Then 10 mg/kg every 2-3 days for 2-8 weeks

  • Max dosage: 125 mg/dose

Vancomycin dosage for endocarditis in pediatric patients 

Vancomycin is approved by the FDA for the treatment of endocarditis in pediatric patients.

• Take 40-60 mg/kg IV every 6-12 hours for at least 4-6 weeks

• Can be used as a combination therapy with rifampin and an aminoglycoside such as gentamicin

Vancomycin dosage for enterocolitis in pediatric patients 

Vancomycin is approved by the FDA for the treatment of Staphylococcus enterocolitis caused by the bacteria Staphylococcus aureus (S. aureus) in pediatric patients younger than 18 years of age. The oral form is used (Vancocin and Fivanq).

• Take 40 mg/kg divided every 6-8 hours per day for 7-10 days

• Max dosage: 500 mg/dose or 2000 mg/day

• Includes treatment of MRSA strains

Vancomycin dosage for pneumonia in pediatric patients 

Vancomycin is approved by the FDA for the treatment of pneumonia due to susceptible isolates of MRSA and coagulase negative staphylococci in community acquired cases for pediatric patients older than 3 months old.

• Take 40-60 mg/kg IV every 6-8 hours for 7-14 days

• May transition to oral antibiotics when appropriate

Vancomycin dosage restrictions

Vancomycin is not considered a first-line antibiotic and should be reserved for more serious, life-threatening infections. If administration of vancomycin is being considered, it is absolutely contraindicated in:

• Those who have a history of hypersensitivity to the medication

• Those with known adverse reactions to corn

• Those who may be pregnant

• Prophylactic use during cataract surgery 

Doses of vancomycin must be altered based on the serum concentrations in the blood to reduce potential adverse effects from the medication. Kidney function (renal) tests monitoring creatinine levels will also be required during the course of the antibiotic to ensure normal renal function of the patient remains.

Patients with the following conditions should also be closely monitored while vancomycin is being administered:

• Known renal impairment

• Senior populations

• Hearing impaired patients

• Currently using an ototoxic drug (potential hearing loss)

• Severe intestinal inflammation

• History of antibiotic-associated colitis 

How to take Vancomycin

Here are some helpful tips while taking vancomycin HCl:

IV version:

• Your doctor will prescribe your exact dose and tell you how often it should be given.

• An IV infusion is medicine that is put directly into your body through one of your veins.

• This medicine should be given by a person trained to give IV medicine, such as a nurse. Sometimes you, a family member, or friend can be taught to give your medicine.

• Check the IV bag to make sure there are no leaks. Also make sure the solution is clear.

Oral version:

• Take a missed dose as soon as you remember. If it is almost time for your next dose, wait until then and take a regular dose. Do not take extra medicine to make up for a missed dose.

• Store the oral liquid in a refrigerator for up to 14 days. Do not freeze. Throw away any unused medicine after 14 days, or if the liquid becomes cloudy or has particles in it.

• Your doctor will tell you how much medicine to use. Do not use more than directed.

• Swallow the capsule whole. Do not crush, open, or chew it.

• Shake the oral liquid well before each use. Measure the oral liquid medicine with a marked measuring spoon, oral syringe, or medicine cup.

• You may mix the oral liquid dose with 2 tablespoons of water. You may add a flavoring syrup to improve the taste of the medicine.

• Take all of the medicine in your prescription to clear up your infection, even if you feel better after the first few doses.

Vancomycin dosage FAQs

How long can you take Vancomycin?

It is important that you take your antibiotics the entire time recommended by your healthcare professional. Even if your symptoms have improved, take the entire course of the antibiotics unless approved by your specialist.

How do I stop taking Vancomycin?

Discontinue vancomycin as instructed by your healthcare provider. This will help prevent superinfections and resistance to the antibiotic from resistant bacteria.

Can you overdose on Vancomycin?

Medical attention is needed immediately if an overdose is suspected while taking vancomycin. Some serious side effects showing signs of toxicity to the drug includes:

• Anaphylaxis

• Infusion reaction from rapid IV use (Red man syndrome)

• Thrombophlebitis (blood clot in one or more veins, usually in the legs)

• Extravasation necrosis (leakage of medication from vein into perivascular space)

• Vasculitis (inflammation of blood vessels that changes blood vessel walls)

• Exfoliative dermatitis (severe inflammation of the skin)

• Stevens-Johnson syndrome (a rare but serious disorder that presents as flu-like symptoms and a painful rash)

• Toxic epidermal necrolysis (life-threatening skin disorder)

• Eosinophilia (high level of white blood cells called eosinophils)

• Acute generalized exanthematous pustulosis (a rare skin reaction that presents as sudden skin eruptions about five days after medication is started)

• Interstitial nephritis (kidney disorder)

• Nephrotoxicity (deterioration of kidney function)

• Ototoxicity (hearing loss)

• Neutropenia (low level of white blood cells called neutrophils)

• Thrombocytopenia (low blood platelet count)

• C. difficile-associated diarrhea

• Superinfection (a second infection resistant to the treatment used for the first infection)

• Hemorrhagic occlusive retinal vasculitis (a rare complication after cataract surgery)

What interacts with Vancomycin?

A complete list of all medications and supplements currently being used must be provided to your healthcare provider to reduce the potential of an allergic reaction when taking multiple medications concurrently. Cidofovir may cause a drug interaction with vancomycin and is absolutely contraindicated.

What happens when you mix Vancomycin and alcohol?

There is no study showing the use of alcohol decreases the effectiveness of vancomycin so there is no contraindication with its use. It is always recommended that you discuss this with your healthcare provider as its use may cause milder side effects such as drowsiness and gastrointestinal pain that can be avoided if alcohol is eliminated while taking this antibiotic.

Is it safe to take Vancomycin during pregnancy?

Currently intravenous vancomycin is not recommended during the first or second trimesters of pregnancy; however, it appears to be safe while breastfeeding. There is little data that shows oral vancomycin is contraindicated during pregnancy and breastfeeding. Although this medication is considered safe, all potential risks and benefits should be discussed with your healthcare provider. 

Related resources for Vancomycin dosages:

• Firvanq, FDA

• Vancocin capsules, FDA

• Vancomycin injection, FDA

• Adult dosing, Epocrates

• Pediatric dosing, Epocrates

• Contraindications, Epocrates

• Drug interactions, Epocrates

• Pregnancy/lactation, Epocrates