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Vancomycin


Presentation

  • Although there was some renal arteriolosclerosis, no vasculitic changes were seen, and no vascular thrombosis was present.[ncbi.nlm.nih.gov]
  • Significant ocular pain can be a presenting sign of HORV in cases with severe iris and ciliary body ischemia.[ncbi.nlm.nih.gov]
  • A man aged 73 years with infective endocarditis presented with septic shock and was started on immediate antimicrobial therapy. His blood culture yielded no organism.[ncbi.nlm.nih.gov]
  • In the present case, the patient was taken to the operating room for a prosthetic infection, and vancomycin was given after cultures were taken.[ncbi.nlm.nih.gov]
  • LABD is considered mostly idiopathic, butsome cases have been reported to be drug-induced, mainly associated with vancomycin (VCM).We present two cases of LABD possibly associated with VCM used for cardiac surgery prophylaxis; in the presented cases,[ncbi.nlm.nih.gov]
Intravenous Administration
  • Red man syndrome (RMS) is a well-known hypersensitivity reaction caused by intravenous administration of vancomycin, with symptoms ranging from flushing, erythematous rash, pruritus, mild to profound hypotension, and even cardiac arrest.[ncbi.nlm.nih.gov]
  • Vancomycin is excreted in human milk after intravenous administration.[medicinenet.com]
  • Although it is known that vancomycin is excreted in human milk based on information obtained from the intravenous administration of the medication, it is not known if vancomycin is excreted into human milk after oral administration.[drugbank.ca]
  • Discussion As described, this reaction is thought to be associated with intravenous administration of the drug, but there are isolated case reports of 'Red Man Syndrome' in association with intraperitoneal and oral administration of vancomycin [ 8, 10[casesjournal.biomedcentral.com]
Pruritus
  • Red man syndrome (RMS) is a well-known hypersensitivity reaction caused by intravenous administration of vancomycin, with symptoms ranging from flushing, erythematous rash, pruritus, mild to profound hypotension, and even cardiac arrest.[ncbi.nlm.nih.gov]
  • ): Pseudomembranous enterocolitis/ colitis Frequency not reported : Chemical peritonitis, constipation, indigestion, stomachache [ Ref ] Metabolic Very common (10% or more): Hypokalemia (up to 13%) [ Ref ] Dermatologic Common (1% to 10%): Exanthema, pruritus[drugs.com]
  • SIDE EFFECTS Infusion-Related Events During or soon after rapid infusion of vancomycin, patients may develop anaphylactoid reactions, including hypotension (see Animal Pharmacology ), wheezing, dyspnea, urticaria, or pruritus.[rxlist.com]
  • The main concern with vancomycin is Hypersensitivity (allergic or due to direct mast-cell degranulation) Vancomycin should be infused over 60 min to avoid red-person syndrome (a histamine-mediated reaction that can cause pruritus and flushing on the face[merckmanuals.com]
  • Additionally, a condition has been reported that is described as being similar to IV-induced symptoms involving symptoms consistent with anaphylactoid reactions, including hypotension, wheezing, dyspnea, urticaria, pruritus, flushing of the upper body[drugbank.ca]
Palpable Purpura
  • Henoch-Schönlein purpura, a vasculitis involving abdominal pain, arthralgias and palpable purpura, is a much less common side effect, as seen in this patient.[ncbi.nlm.nih.gov]
  • We report an elderly patient with the end-stage renal disease presented with diffuse palpable purpura while receiving IV vancomycin therapy for methicillin-resistant Staphylococcus aureus septicemia.[ncbi.nlm.nih.gov]
Hemorrhagic Bullae
  • We report a case of a previously healthy 77-year-old man who developed a diffuse macular rash and hemorrhagic bullae on the left leg 10 days after placement of a vancomycin-impregnated cement spacer (VICS) during a revision knee arthroplasty and initiation[ncbi.nlm.nih.gov]

Workup

Albuminuria
  • BACKGROUND: The performance of a population pharmacokinetic model in predicting trough concentrations after the initial vancomycin dose was evaluated in patients with albuminuria compared with patients who did not have albuminuria.[ncbi.nlm.nih.gov]
Microalbuminuria
  • CONCLUSIONS: Microalbuminuria in patients with diabetes is a marker of the difference between predicted vancomycin trough concentrations and actual vancomycin trough concentrations.[ncbi.nlm.nih.gov]

Treatment

  • RESULTS: 42 patients were enrolled and 64% had treatment failure.[ncbi.nlm.nih.gov]
  • […] of malignancy itself, may have a crucial impact on treatment success.[ncbi.nlm.nih.gov]
  • Tubulointerstitial nephritis is also a rare association with vancomycin treatment.[ncbi.nlm.nih.gov]
  • Thereafter, intraventricular vancomycin was added which resulted in good treatment response.[ncbi.nlm.nih.gov]
  • First-line treatment with vancomycin and rifampicin failed, and daptomycin was thus administered. After several days, the treatment was changed to linezolid because of the re-emergence of fever.[ncbi.nlm.nih.gov]

Prognosis

  • The 2 cases illustrate the broad range of toxicity potentially associated with intracameral vancomycin, suggest that bilateral administration results in a worse prognosis, and indicate that this disorder may be underrecognized due to the potential for[ncbi.nlm.nih.gov]
  • MRSA exhibiting vancomycin-creep portends a poorer prognosis and requires aggressive therapy. We advocate the use of ceftaroline salvage therapy with daptomycin, pending further trials. 2015 BMJ Publishing Group Ltd.[ncbi.nlm.nih.gov]

Etiology

  • Inpatient vancomycin use is increasing and appears to be emerging as an important etiology of DRESS syndrome. This study highlights the importance of vancomycin as a cause of DRESS syndrome.[ncbi.nlm.nih.gov]
  • Anesthesiology 1998, 89: 620-625. 10.1097/00000542-199809000-00010 View Article PubMed Google Scholar Ross M: Red-man syndrome: a preventable adverse drug reaction. [ ] Wallace M, Mascola J, Oldfiels E Ill: Red-man syndrome: Incidence, etiology, and prophylaxis[doi.org]
  • Infectious Disease Society of America (IDSA) guidelines, piperacillin-tazobactam is appropriate as monotherapy, as it has excellent gram negative and anaerobic coverage. [19] The exception to this would be intra-abdominal infections secondary to a biliary etiology[emdocs.net]
  • […] related to HD procedure stand out: double-lumen catheter as the most common venous access (65%); dialysis capillary reuse time ranging from 1-19 days, median of three days; association of diabetes mellitus and arterial hypertension as the most frequent etiology[scielo.br]

Epidemiology

  • CONCLUSION: This case report illustrates the importance of fully understanding the changing epidemiology of infectious agents and the risk factors for the development of antibiotic resistance.[ncbi.nlm.nih.gov]
  • , the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, and the Surgical Infection Society.[wonder.cdc.gov]
  • Recurrent Clostridium difficile disease: epidemiology and clinical characteristics. Infect. Control Hosp. Epidemiol. 20 : 43 -50. Mody, L. R., S. M. Smith, and L. L. Dever. 2001.[doi.org]
  • Cohen SH, Gerding DN, Johnson S, et al; Society for Healthcare Epidemiology of America; Infectious Diseases Society of America.[jamanetwork.com]
Sex distribution
Age distribution

Pathophysiology

  • To derive novel insights into the pathophysiology of vancomycin-related hemorrhagic occlusive retinal vasculopathy (HORV) through a careful clinicopathologic correlation.[ncbi.nlm.nih.gov]
  • “Principles of Pharmacology: The Pathophysiologic Basis of Drug Therapy”, 2nd edition. LWW: 2008. Harvey, R; Champe, P (series editors). “Lippincott illustrated reviews: Pharmacology”, 4th edition. LWW: 2009.[pharmacologycorner.com]
  • […] clinical disorders or settings where the test may be helpful Monitoring adequacy of drug concentration during vancomycin therapy whenever a specimen is submitted or collected without collection timing information Clinical Information Discusses physiology, pathophysiology[mayomedicallaboratories.com]
  • Other pathophysiologic mechanisms may be by direct toxicity to bone marrow or peripheral cells, hypersensitivity, immunological defects secondary to viral infections, mixed or unknown mechanisms.[scielo.org.co]

Prevention

  • CONCLUSION: Adding intraoperative vancomycin to a shunt infection prevention protocol significantly reduces CSF shunt infection rate.[ncbi.nlm.nih.gov]
  • […] the preceding section (see Preventing and Controlling VRE Transmission in All Hospitals).[wonder.cdc.gov]
  • Because of steric hindrance, the binding of either molecule to the substrate prevents the binding of the other molecule.[doi.org]
  • Recommendations for Preventing the Spread of Glycopeptide-Resistant Staphylococci.[doi.org]

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