Vancomycin for ORAL USE in adults

Administration and monitoring

Vancomycin is used orally to treat C.difficile infection. Vancomycin for oral use is available as capsules or vancomycin injection that is licensed for oral use

1. Monitoring

• Oral vancomycin is not typically systemically absorbed. Absorption may, however, be enhanced in patients with inflammatory disorders of the intestine or Clostridoides difficile-induced pseudomembranous colitis and monitoring of vancomycin levels is recommended in such patients irrespective of vancomycin dose.
• Vancomycin therapeutic drug monitoring (TDM) is required in all patients if high dose vancomycin (500mg QDS) po/ng is prescribed.
• First pre-dose level should be taken on the third day of the vancomycin course. Further levels should be taken twice weekly. Pre-dose levels should be <20mg/L.
• Monitoring should include renal function. Risk of ototoxicity should be monitored in patients where systemic absorption may be significant.

2. Preparation of a vancomycin solution for oral administration:

• Add 10ml of Water for Injections to vials containing 500mg vancomycin powder. This gives a solution strength of 50mg/ml.
• For a dose of 125mg vancomycin, draw up 2.5ml of solution.
• For a dose of 500mg vancomycin, draw up 10ml of solution.
• Each dose should then be diluted with 30ml of sterile water (to minimise GI side effects).
• After ng administration, ng tube should be flushed with 10ml water.
• Vials are for single use only and any remaining volume should be disposed of immediately.