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Vancomycin is an antibiotic that is used to treat bacterial infections. It is available in generic form as well as under brand names such as Vancocin and Firvanq (oral solution). In addition to its expected effects, vancomycin can also cause some unwanted effects. Some of these side effects can be serious, requiring emergency medical care. Please continue reading to learn more about vancomycin side effects and when to call your healthcare professional.

Is vancomycin a strong antibiotic?

Vancomycin is a strong antibiotic that is effective against a wide range of Gram-positive bacteria, including methicillin-susceptible Staphylococcus aureus (MSSA),  methicillin-resistant Staphylococcus aureus (MRSA), streptococci, and enterococci.

What is vancomycin used to treat?

The U.S. Food and Drug Administration (FDA) approved oral vancomycin for the treatment of Clostridium difficile-associated diarrhea (CDAD). It is also used to treat enterocolitis (inflammation of the digestive tract) caused by Staphylococcus aureus (both methicillin-susceptible and methicillin-resistant strains). Vancomycin has to be taken orally (by mouth) to treat these infections. 

Notably, oral administration of vancomycin is not effective for infections in other parts of the body, such as endocarditis (inflammation of the inner lining of the heart), septicemia (blood poisoning), lower respiratory tract infections, skin and soft tissue infections, and bone infections. Besides the treatment of CDAD and Staphylococcus enterocolitis, vancomycin is administered intravenously (into the vein) to treat other types of infection. 

Therefore, oral vancomycin is used to treat the above-mentioned gastrointestinal infections, and parenteral vancomycin (intravenous injection) is used for other types of infections.

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What are the common side effects of vancomycin?

Common side effects of vancomycin include nausea, vomiting, diarrhea, gas, stomach pain, fever, edema (swelling), fatigue, urinary tract infections, low potassium, back pain, and headache.

Older adults (age 65 years and above) are more likely to have side effects such as hypokalemia (low potassium), urinary tract infection, peripheral edema (swelling in the hands and feet), insomnia, constipation, depression, anemia, vomiting, and low blood pressure. 

You should call your doctor for medical advice about vancomycin side effects if they are severe or persist after a few days.

What is the most serious side effect of vancomycin?

Rarely, vancomycin can cause more serious adverse effects. You should tell your doctor immediately or seek emergency medical attention if you develop the following serious symptoms:

• Systemic symptoms of infection, such as fever, chills, fatigue, swollen glands, sore throat, cough

• Difficulty breathing or swallowing

• Skin rash, redness, skin puffiness, skin scaling, hives, itching (signs of an allergic or hypersensitivity reaction)

• Mouth irritation 

• Blisters or sores on the lips or tongue

• Red skin lesions above the waist level

• Muscle tightness or muscle pain

• Back pain

• Chest pain

• Irritated eyes

• Ringing in the ears or some other unexplained noise in the ears

• Swelling of the face, hands, arms, feet, ankles, or lower legs

• Unusual bleeding or bruising

• Unusual tiredness or weakness

• Unusual weight gain

• Decreased urination

What organ is vancomycin hard on?

Vancomycin can be hard on the kidneys. There are reports of acute kidney injury and acute renal failure after taking vancomycin. Vancomycin can also damage hearing. These side effects occur more commonly in elderly patients (age 65 and above). 

Before starting vancomycin, tell your doctor if you have a history of chronic kidney disease or hearing problems, including hearing loss. Also, tell your healthcare provider if you have a history of inflammatory bowel disease (Crohn’s disease or ulcerative colitis).

Before starting treatment with vancomycin, your doctor will order blood work such as a CBC (complete blood count), CMP (comprehensive metabolic panel), or BMP (basic metabolic panel). These blood works can give your doctor more information regarding infection, inflammation, electrolyte levels, and kidney function. 

Even without a history of chronic kidney disease, in the setting of dehydration due to nausea, vomiting, diarrhea, or poor oral intake, acute kidney injury can happen, and increased serum creatinine can be one of the first signs of it. 

If you have any kidney problem (acute, chronic, or acute-on-chronic), it doesn't mean you can't receive vancomycin. Your doctor will determine if vancomycin is the best regimen for you and the appropriate dose based on your kidney function.  

What precautions to take before starting vancomycin?

Tell your doctor if you have a history of hypersensitivity reactions (drug rash or drug fever) after taking vancomycin, other antibiotics, or any other medications.

Before starting vancomycin therapy, give your doctor a complete list of all your other medications. This will help prevent drug-drug interactions. Check with your doctor before starting any new medications while on vancomycin. 

Tell your doctor if you are pregnant, could be pregnant, planning a pregnancy in the near future, or breastfeeding. 

What to expect after taking vancomycin?

Oral vancomycin is the first-line treatment for C. difficile-associated diarrhea that can occur after antibiotic treatment. If you have severe watery or bloody diarrhea, you should start to notice an improvement in your symptoms within a few days of starting vancomycin. Tell your doctor if your symptoms do not improve or get worse. 

Oral vancomycin dosing for C. difficile-associated diarrhea (CDAD) may vary depending on the severity of the illness and whether it is the first episode or a recurrence. 

For the initial episode, oral vancomycin is typically dosed four times daily for ten days. For recurrent episodes, vancomycin is dosed for ten days or longer. The care team will provide you with specific instructions on how to take oral vancomycin.

Continue taking vancomycin until you finish the prescribed course, even if you are feeling better or your symptoms are gone. You can treat mild illness at home with oral vancomycin or other agents; severe CDAD typically requires hospitalization for close monitoring. 

If you miss a dose of vancomycin, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take a double dose or extra medicine to make up for a missed dose.