Drug products: Vancocin, Vancocin®, Vancomycin "Lederle", Vancomycin Actavis, Vancomycin Dr. Eberth, Vancomycin Hospira, Vancomycin MIP, Vancomycin Mylan, Vancomycin Orion, Vancomycin Sandoz, Vancomycin Strides, Vancomycin Xellia
ATC code: A07AA09, J01XA01
Substances: vancomycin, vancomycin hydrochloride
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.
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 . 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 .
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) . Comparable results where showed in a similar study in septic patients .
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 .
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 .
Regarding teratogenic aspects, please consult Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan).
Date of litterature search: 2016-06-01
Reviewed by: Mia von Euler
Approved by: Karin Schenck-Gustafsson