Vancomycin
Classification: AATC code: A07AA09, J01XA01
Summary
Published controlled studies on differences between men and women in vancomycin efficacy are lacking.
Small studies have shown that women have lower vancomycin clearance than men, also critically ill women achieve adequate concentrations of vancomycin within 48 h to a higher degree than men after weight-based IV treatment. This emphasizes the importance of drug monitoring to ensure correct dosing in men and women.
In our opinion, the described differences do not motivate differentiated dosing or treatment in men and women.
Additional information
Pharmacokinetics and dosing
Pharmacokinetic studies have shown that women have lower clearance than men, varying from 15-25% [1-3]. A small study (26 men, 4 women) showed that women had 34% lower clearance than men, however, since the study included very few women the results might be skewed [2]. One study also showed that women had higher volume of distribution than men when comparing patients of similar age and body weight. These sex differences appeared to be greater in obese patients [3].
Adequate concentrations of vancomycin in critically ill patients are attained by using a weight-based IV loading dose followed by a continuous IV infusion. A study (154 men, 73 women) showed that female sex was associated with early (<48h) adequate vancomycin levels in critically ill patients (odds ratio 4.2, 95%CI 1.6-10.9) [4]. Comparable results where showed in a similar study in septic patients [5].
Effects
No placebo-controlled studies of sex differences in response to vancomycin have been found. Studies comparing vancomycin and metronidazole in treatment of Clostridium difficileinfection have not shown any sex differences in response [6, 7] or risk of second recurrence [8].
Adverse effects
High doses of vancomycin are associated with increased risk of nephrotoxicity. A multivariate analysis of 165 men and 123 women showed no sex or age differences in the risk (odds ratio 0.99). The multivariate analysis showed Afro-Americans, patients with heart failure or metastatic disease to have a higher risk [9].
Reproductive health issues
Regarding teratogenic aspects, please consult the Drugs and Birth Defects Database (in Swedish, Janusmed fosterpåverkan).
Updated: 2019-02-26
Date of litterature search: 2016-06-01
References
- Chung JY, Jin SJ, Yoon JH, Song YG. Serum cystatin C is a major predictor of vancomycin clearance in a population pharmacokinetic analysis of patients with normal serum creatinine concentrations. J Korean Med Sci. 2013;28:48-54. PubMed
- Mangin O, Urien S, Mainardi JL, Fagon JY, Faisy C. Vancomycin pharmacokinetic and pharmacodynamic models for critically ill patients with post-sternotomy mediastinitis. Clin Pharmacokinet. 2014;53:849-61. PubMed
- Ducharme MP, Slaughter RL, Edwards DJ. Vancomycin pharmacokinetics in a patient population: effect of age, gender, and body weight. Ther Drug Monit. 1994;16:513-8. PubMed
- De Waele JJ, Danneels I, Depuydt P, Decruyenaere J, Bourgeois M, Hoste E. Factors associated with inadequate early vancomycin levels in critically ill patients treated with continuous infusion. Int J Antimicrob Agents. 2013;41:434-8. PubMed
- Ocampos-Martinez E, Penaccini L, Scolletta S, Abdelhadii A, Devigili A, Cianferoni S et al. Determinants of early inadequate vancomycin concentrations during continuous infusion in septic patients. Int J Antimicrob Agents. 2012;39:332-7. PubMed
- Johnson S, Louie TJ, Gerding DN, Cornely OA, Chasan-Taber S, Fitts D et al. Vancomycin, metronidazole, or tolevamer for Clostridium difficile infection: results from two multinational, randomized, controlled trials. Clin Infect Dis. 2014;59:345-54. PubMed
- Mezoff E, Mann EA, Hart KW, Lindsell CJ, Cohen MB. Clostridium difficile infection and treatment in the pediatric inflammatory bowel disease population. J Pediatr Gastroenterol Nutr. 2011;52:437-41. PubMed
- Pépin J, Routhier S, Gagnon S, Brazeau I. Management and outcomes of a first recurrence of Clostridium difficile-associated disease in Quebec, Canada. Clin Infect Dis. 2006;42:758-64. PubMed
- Bosso JA, Nappi J, Rudisill C, Wellein M, Bookstaver PB, Swindler J et al. Relationship between vancomycin trough concentrations and nephrotoxicity: a prospective multicenter trial. Antimicrob Agents Chemother. 2011;55:5475-9. PubMed
- Concise. Stockholm: eHälsomyndigheten. 2015 [cited 2016-06-30.] länk
- Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2015 [cited 2016-06-30.] Socialstyrelsens statistikdatabas
Reviewed by: Mia von Euler
Approved by: Karin Schenck-Gustafsson