Vancomycin is a time-dependent, bactericidal antibiotic that inhibits cell wall synthesis. Pharmacology Vancomycin is practically nichtresorbiert after oral administration of the normal GI tract. After parenteral administration, it penetrates into the bile and pleural, pericardial, synovial and ascites. However, the penetration into the inflamed CSF is small and irregular. Vancomycin is excreted unchanged by glomerular filtration. Indications Vancomycin is active against most Gram-positive cocci and rods, including virtually all Staphylococcus aureus and coagulase-negative staphylococci strains that are resistant to penicillin and cephalosporins. However, many strains of enterococci (a bacteriostatic mechanism) many strains of enterococci and some strains of S. aureus are resistant. Vancomycin is a drug of choice for severe infection and endocarditis due to the following reasons (except for vancomycin-resistant strands): methicillin-resistant S. aureus, methicillin-resistant coagulase-negative staphylococci Certain ?-lactam and multi-drug resistant Streptococcus pneumoniae ?-hemolytic streptococci ( if ?-lactam are not used due to a drug allergy or resistance) Corynebacterium group JK viridans streptococci (if ?-lactam are not used due to a drug allergy or resistance) enterococci (if ?-lactam can not be used due to a drug allergy or resistance) Nonetheless vancomycin is less effective as an anti-staphylococcal ?-lactam with S. aureus endocarditis. Vancomycin is used with other antibiotics for the treatment of methicillin-resistant coagulase Klappenendokarditis by negative staphylococci and enterococci endocarditis. Vancomycin was used as alternative medicine for pneumococcal meningitis, which was caused by strains with reduced susceptibility to penicillin; although the erratic penetration of vancomycin in the cerebrospinal fluid (especially during simultaneous administration of dexamethasone), and reports of clinical failure indicates that vancomycin is only suboptimal as a single agent in the treatment of pneumococcal meningitis. Oral Vancomycin is used to treat Clostridium difficile-induced diarrhea (pseudomembranous Kolitis- Clostridium difficile -induced diarrhea) are used. It is metronidazole for patients who have severe C. difficile infection, preferred and is used for patients who do not respond to metronidazole, is preferred. Contraindications vancomycin in patients who have had an allergic reaction to it, contraindicated. Use during pregnancy and lactation vancomycin had no adverse effects in animals and evidence in human studies are insufficient. Oral vancomycin tablets are in pregnancy category B (animal studies show no risk, human experience is incomplete or animal studies show risk, but human studies do not). Oral vancomycin and vancomycin solution i.v. belong to the category C of (animal studies show some risk indications in human and animal studies are insufficient, but sometimes clinical benefit outweighs the risk). Vancomycin is excreted in breast milk and so is not recommended for use during the breast-feeding; but because it is poorly reabsorbed from a normal GI tract side effects in children usually are considered unlikely side effects mainly hypersensitivity (allergic or due to direct mast cell degranulation) vancomycin to a “Red-Man should be infused over ? 60 minutes syndrome “(a histamine-mediated reaction that leads to itching and rashes on the face, neck and shoulders leads) to be avoided. Other hypersensitivity reactions (. Eg rash, fever) may occur; especially at a treatment duration> 2 weeks. Other side effects include reversible neutropenia and thrombocytopenia. Nephrotoxicity is rare, unless high doses are used, or an aminoglycoside is administered simultaneously. Occasionally, during an i.v. Infusion phlebitis. Dose-dependent ototoxicity is unusual in the usual formulations; the incidence is increased when vancomycin is administered in conjunction with other ototoxic drugs. Considerations Dosage The dose in meningitis must be higher than usual. In renal insufficiency, a dose reduction is required. In critically ill patients, the trough levels should be monitored according to the 2nd or 3rd dose and 15-20 ug / ml are maintained. Vancomycin MIC for many pathogens has increased during the last ten years. The sensitivity of S. aureus based on vancomycin MIC is as follows: ? 2 ug / ml: Sensitive 4 to 8 ug / ml: Zwischenstuflich> 8 g ??/ ml: Resistant However speak infections due to S. aureus with a vancomycin MIC of 2 -8 g / ml only suboptimal to the standard dosage and make higher doses with trough concentrations between 15-20 ug / ml required, but this approach may be complicated by higher Nephrotoxizitätsraten.