12.14 Tricyclic Glycopeptides
Vancomycin is a tricyclic glycopeptide antibiotic commonly used to treat MRSA.
Indications for Use:
Vancomycin is a popular glycopeptide that is active against gram-positive bacteria. Vancomycin is commonly used to treat serious or severe infections when other antibiotics are ineffective or contraindicated, including those caused by MRSA. It is useful with staph infections including endocarditis, meningitis, osteomyelitis and septicemia. Oral vancomycin is used to treat antibiotic-associated clostridium difficile (C-diff).
Mechanism of Action:
Glycopeptides are a class of medications that bind to the bacterial cell wall, inhibiting bacterial cell wall synthesis.
Nursing Considerations:
Administration: Can be given IV or oral. It is poorly absorbed in the GI tract, so it is only given orally for intestinal infections.
IV route is the preferred route for systemic infections.
IV: risk of phlebitis. Monitor IV site closely and rotate IV sites. May cause severe pain and necrosis in vein.
High alert med: Vancomycin poses a significant risk to kidney function and hearing; therefore, clients’ trough levels must be monitored carefully for effective IV dosing to avoid complications. Reduced renal function can cause vancomycin to accumulate in the body, thereby increasing the risk of adverse effects.
Pregnancy: Do not use during pregnancy unless benefits outweigh the risk. Vancomycin crosses the placenta and can cause fetal ototoxicity and nephrotoxicity.
Adverse/Side Effects
Common side effects for oral dosing include nausea, vomiting, abdominal pain, and diarrhea. Dysgeusia, or a distorted sense of taste, is another common adverse reaction unique to oral vancomycin administration.
Potential side effects for IV dosing include:
- Risk of “red man syndrome” with IV dosing. Results in flushing of the skin and a reddish rash on the upper body when the infusion is administered too rapidly.
- Phlebitis
- Hypotension, monitor BP during IV therapy
- Other effects include: drug fever, skin rash, eosinophilia, and reversible neutropenia.
Risk of nephrotoxicity: assess for pink or cloudy urine, decreased urine output, abdominal pain.
(Patel, Preuss & Bernice, 2024; Vallerand & Sanoski, 2024)
Client Teaching:
- Clients should be counselled to take medications as directed for the full course of antibacterial therapy.
- They should monitor for side effects such as hypersensitivity, tinnitus, hearing loss, and vertigo.
- Clients should promptly follow up with their healthcare provider if no improvement in symptoms is identified (UpToDate, 2021).
Vancomycin Medication Card
Now let’s take a closer look at the medication card on vancomycin (Daily Med, 2019). Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication.
To help with comparing the medications and to learn important considerations for each medication, refer to the Chapter 12 Antimicrobials Medication Cards
Medication Card: Tricyclic Glycopeptide
Prototypes: Vancomycin
Mechanism of Action: Bind to bacterial cell wall, inhibiting cell wall synthesis and RNA synthesis.
Indications
- Generally only used for serious staphylococcal infections: MRSA
- Effective against Gram + organisms.
- Vancomycin resistant enterococcus (VRE); C-diff (pseudomembranous colitis)
- Bone and blood infections
Administration
- IV only (except for C. diff, PO)
- SE can be minimized if infusion rate is slowed
- IV should be administered in a diluted solution over a period of 60 minutes or more to avoid rapid-infusion-related reactions
- Narrow therapeutic range, monitor trough levels.
Side Effects
- Nausea, hypotension
- Ototoxicity, nephrotoxicity
- Neutropenia
- Blood disorders
- “Red man syndrome” [not harmful] Flushing, redness, itchiness upper trunk, face, head
- Dosage adjustment is required for renal impairment
Contraindications
Contraindicated in:
- Neuromuscular blockers
- Hearing impairment
- Kidney dysfunction
- Neonates and older adult
Maintain hydration
Monitor urine output
Narrow TR: very low dose = no effect, high dose = toxic
Clinical Reasoning and Decision-Making Activity
Using the above information, consider the following clinical scenario question:
- A nurse is caring for a client who was prescribed vancomycin IV for a MRSA infection. The dose of medication is due now, but a trough level is not yet available in the chart. What is the nurse’s next best response?
2. A client is on an oral dose of Vancomycin for pseudomembranous colitis caused by Clostridium difficile. What lab results and assessments should the nurse be carefully monitoring?
Note: Answers to the Clinical Reasoning Activities and Critical Thinking questions can be found in the Chapter 12: Antimicrobial Medications answer key – Fundamentals of Nursing Pharmacology – 2nd Canadian Edition section at the end of the book.
References
Daily Med, https://dailymed.nlm.nih.gov/dailymed/index.cfm, used for hyperlinked medications in this module. Retrieved June 27, 2019 ↵
Patel, S. Preuss, C. & Bernice, F. (2024). Vancomycin. National Library of Medicine. StatPearls. Vancomycin – StatPearls – NCBI Bookshelf
UpToDate (2021). Vancomycin. https://www.uptodate.com/contents/search ↵
Vallerand, A. & Sanoski, C. (2024). Davis’s Canadian drug guide for nurses (19th ed.). F.A. Davis Company: Canada
