Vancomycin
Pronunciation: pronunciation varies by local usage.
- Generic name
- vancomycin hydrochloride
- Drug class
- Glycopeptide antibiotic
- Form
- Intravenous solution, oral solution, oral capsule
- Route
- Intravenous injection; oral solution or capsule
- Legal status
- Prescription-only medicine
Availability and supply rules vary by country
Trade names by country: United States · Canada
Australia: · Full directory
What vancomycin hydrochloride is and how it works
Vancomycin is a glycopeptide antibiotic available in two distinct formulations: an intravenous injection for serious systemic gram-positive bacterial infections, including methicillin-resistant Staphylococcus aureus (MRSA), and an oral solution or capsule that acts locally in the gut for Clostridioides difficile-associated diarrhea and staphylococcal enterocolitis. (1) (2)
The intravenous and oral formulations are not interchangeable. The oral formulation is not effective for infections outside the gastrointestinal tract. IV vancomycin requires hospital or clinic administration with monitoring of renal function, hearing, and blood counts. A specialist must confirm the indication, formulation, and monitoring plan.
Mechanism of action: how vancomycin hydrochloride works
Vancomycin is a glycopeptide antibiotic active against susceptible gram-positive bacteria. The intravenous formulation provides systemic treatment, while the oral formulation is poorly absorbed from the gastrointestinal tract and acts locally for C. difficile-associated diarrhea and staphylococcal enterocolitis. (1) (2)
What vancomycin hydrochloride is used for
Serious systemic gram-positive infections (IV formulation)
Intravenous vancomycin is indicated for the treatment of septicemia, infective endocarditis, skin and skin-structure infections, bone infections, and lower respiratory tract infections caused by susceptible gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). (1)
Clostridioides difficile-associated diarrhea and staphylococcal enterocolitis (oral formulation)
Oral vancomycin hydrochloride is indicated for the treatment of C. difficile-associated diarrhea and staphylococcal enterocolitis. Orally administered vancomycin is not effective for other types of infections because it is poorly absorbed from the gastrointestinal tract into the bloodstream. (2)
Before taking vancomycin hydrochloride
Do not take / not appropriate for
- Do not receive vancomycin if you have a known hypersensitivity to vancomycin. (all products) (1)
- Do not receive dextrose-containing vancomycin solutions if you have a corn allergy, because of the dextrose source. (dextrose-containing IV solutions) (1)
- Do not use oral vancomycin to treat infections outside the gastrointestinal tract. (oral formulation) (2)
Tell your clinician about
- Any history of hearing loss, tinnitus, dizziness, or kidney problems.
- Any previous allergic reaction to vancomycin or any other antibiotic.
- All current medicines, especially other antibiotics, aminoglycosides, piperacillin/tazobactam, anesthetic agents, or any other nephrotoxic or ototoxic drugs.
- Pregnancy, plans for pregnancy, or breastfeeding.
- Any history of inflammatory bowel disease or recent diarrhea, as this may affect absorption of oral vancomycin.
How to take vancomycin hydrochloride
- Intravenous vancomycin is administered in a healthcare setting by a clinician over a minimum of 60 minutes per dose to reduce the risk of infusion-related reactions.
- The total daily adult IV dose is typically 2 grams, divided either as 500 mg every 6 hours or 1 g every 12 hours, with an initial loading dose of at least 15 mg/kg.
- Oral vancomycin is taken by mouth for C. difficile-associated diarrhea or staphylococcal enterocolitis; it acts locally in the gut.
- Do not change the dose, interval, or formulation yourself. IV and oral formulations are not interchangeable.
Procedures and treatment changes
Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1) (2)
Missed dose
For IV vancomycin administered in a healthcare setting, missed-dose management is handled by the clinical team. For oral vancomycin, specific missed-dose guidance was not established from the sources reviewed; contact the prescribing clinician.
Overdose
Management of vancomycin overdose is supportive care, with attention to maintaining glomerular filtration. Vancomycin is poorly removed by standard hemodialysis; hemofiltration and hemoperfusion may increase clearance. In the US, contact the National Poison Control service (1-800-222-1222) for suspected overdose. (1)
Side effects
Adverse effects can include kidney injury, hearing loss, infusion-related reactions, severe skin reactions, and blood count changes. Monitoring is required throughout treatment.
Infusion-related reaction (Red Man Syndrome)
What to notice: Flushing or erythema of the face and neck, itching, wheezing, chest or muscle pain, and in severe cases hypotension, shock, or cardiac arrest. Occurs with rapid infusion.
What to do: This is a reason the infusion is given over at least 60 minutes. Tell the treating clinician immediately if symptoms occur during or shortly after infusion. (1)
Nephrotoxicity (acute kidney injury)
What to notice: Changes in urine output, swelling, fatigue, or abnormal kidney function tests. Risk increases with higher vancomycin levels, prolonged treatment, and concurrent nephrotoxic drugs including piperacillin/tazobactam.
What to do: Kidney function is monitored during treatment. Report any new symptoms to the treating team. (1)
Ototoxicity (hearing loss, tinnitus, dizziness)
What to notice: Ringing in the ears, dizziness, or reduced hearing. Risk is higher with advanced age, higher doses, pre-existing hearing loss, and concurrent aminoglycosides. May be reversible or permanent.
What to do: Report any hearing changes or dizziness to the treating clinician. Auditory function testing may be performed for high-risk patients. (1)
Rash, nausea, neutropenia (low white blood cells)
What to notice: Skin rashes, nausea, or changes in white blood cell count with prolonged therapy.
What to do: Discuss persistent or troublesome symptoms with the treating team. (1)
DRESS syndrome or severe skin reactions
What to notice: Widespread rash, fever, swollen lymph nodes, facial swelling, or organ involvement. Toxic epidermal necrolysis and Stevens-Johnson syndrome have also been reported.
What to do: Seek medical attention promptly. Let the clinician you see advise on whether to continue or stop vancomycin. (1)
C. difficile-associated diarrhea
What to notice: New or worsening diarrhea during treatment or in the months after treatment.
What to do: Report diarrhea to the treating clinician for assessment. (1)
Anaphylaxis
What to notice: Severe allergic reaction including breathing difficulty, throat swelling, hives, or collapse.
What to do: This is a medical emergency. Seek immediate emergency care. (1)
Serious warnings
Severe infusion reaction (rapid administration) — emergency
Symptoms: Severe hypotension, shock, cardiac arrest, wheezing, urticaria, chest pain, or severe flushing.
Action: Infusion must be stopped and emergency medical care provided immediately by the clinical team. This is a reason the label specifies a minimum infusion time of 60 minutes. (1)
DRESS syndrome / severe dermatologic reactions — severe
Symptoms: Widespread severe rash, fever, eosinophilia, facial edema, lymphadenopathy, or organ involvement. Toxic epidermal necrolysis and Stevens-Johnson syndrome have been reported.
Action: Seek emergency medical assessment promptly. Let the clinician you see advise on whether to continue or stop vancomycin. (1)
Anaphylaxis — emergency
Symptoms: Difficulty breathing, throat or tongue swelling, hives, faintness, or collapse.
Action: This is a medical emergency. Seek immediate emergency care. (1)
Interactions
| Medicine or test | Effect | Action |
|---|---|---|
| Concurrent anesthetic agents | Associated with erythema and a histamine-like flushing reaction. | Inform the anesthetist and treating clinician of vancomycin treatment before any procedure requiring anesthesia. (1) |
| Piperacillin/tazobactam | Concurrent use is associated with an increased incidence of acute kidney injury. | Kidney function must be monitored closely if these medicines are used together. (1) |
| Other nephrotoxic or ototoxic drugs (including aminoglycosides) | Increased risk of kidney damage and hearing loss; risk may be additive. | More frequent monitoring of renal function and hearing is required. Give the clinician a complete medication list. (1) |
Pregnancy, breastfeeding, kidney/liver function, age
People with renal impairment or on dialysis
The initial IV dose remains 15 mg/kg regardless of renal function; subsequent doses and intervals are adjusted based on measured trough levels and renal function. In functionally anephric patients, serum vancomycin concentrations should be measured approximately 24 hours after a dose to guide further therapy. Clinically significant serum vancomycin concentrations have been reported in some patients with renal impairment after multiple oral doses given for active C. difficile-associated diarrhea. (1) (2)
People at higher risk of ototoxicity
Risk of hearing loss, tinnitus, and dizziness is higher with advanced age, higher vancomycin doses, pre-existing hearing loss, and concurrent aminoglycoside therapy. Auditory function testing may be performed. (1)
Pregnancy
Available human data have not identified a drug-associated risk of major birth defects or adverse pregnancy outcomes. Animal reproduction studies did not show developmental effects at the recommended maximum human dose. Discuss with the treating clinician. (1)
Breastfeeding
Vancomycin is present in human milk. There is insufficient data on effects in the breastfed infant. Discuss the benefits and risks with the treating clinician. (1)
Patients with inflamed intestinal mucosa receiving oral vancomycin
Clinically significant serum vancomycin concentrations have been reported in some patients after multiple oral doses given for active C. difficile-associated diarrhea, particularly when the intestinal mucosa is inflamed and/or renal impairment is present. (2)
Monitoring
Before starting
- Confirm the exact indication and select the correct formulation (IV for systemic infections; oral for C. difficile-associated diarrhea/staphylococcal enterocolitis).
- Assess baseline renal function (BUN and serum creatinine), hearing status, and white blood cell count.
- Review all concurrent medicines for nephrotoxic or ototoxic potential, especially aminoglycosides, piperacillin/tazobactam, and anesthetic agents.
- Confirm there is no history of hypersensitivity to vancomycin and no corn allergy if a dextrose-containing solution is planned.
During treatment
- Monitor serum vancomycin trough concentrations to guide dosing adjustments.
- Monitor renal function (BUN and serum creatinine) regularly throughout treatment.
- Monitor auditory function in patients at higher risk of ototoxicity.
- Monitor leukocyte (white blood cell) count with prolonged therapy.
- Monitor for new or worsening diarrhea during treatment and for a period of months afterward, as nearly all antibacterial agents have been associated with C. difficile-associated diarrhea.
- Ensure each IV dose is administered over a minimum of 60 minutes to reduce the risk of infusion-related reactions.
Storage
Intravenous vancomycin is prepared and stored by the healthcare facility according to pharmacy protocols. For oral vancomycin, specific patient-level storage instructions were not established from the sources reviewed; follow the pharmacy label and product packaging.
Study the drug class: Glycopeptides
Professional information
Clinician-facing context only. Use the current local label, institutional dosing and monitoring protocols, and the specific formulation (IV vs oral) product information.
United States (US FDA label)
Indication: Intravenous vancomycin for serious gram-positive infections
Dose summary: Adult total daily dose: 2 grams, divided as 500 mg every 6 hours or 1 g every 12 hours. Initial/loading dose: minimum of 15 mg/kg. Each dose administered over at least 60 minutes. Pediatric IV dosing was not established from the sources reviewed in this pass.
Renal context: Initial dose remains 15 mg/kg regardless of renal function. Subsequent doses and intervals are adjusted based on measured trough levels and renal function. In functionally anephric patients, measure serum vancomycin concentrations approximately 24 hours after a dose to guide further therapy. (1)
United States (US FDA label)
Indication: Oral vancomycin for C. difficile-associated diarrhea and staphylococcal enterocolitis
Dose summary: Specific oral dosing regimen (mg per dose, frequency, duration) was not established from a full direct source read in this pass and is therefore not stated. Oral vancomycin is indicated for these gastrointestinal infections only and acts locally in the gut.
Renal context: Clinically significant serum vancomycin concentrations have been reported in some patients with renal impairment after multiple oral doses for active C. difficile-associated diarrhea; monitoring may be warranted. (2)
Hepatic guidance
Specific hepatic-impairment dosing was not established from the sources reviewed; use local product information and specialist judgement.
Overdose note
Supportive care with attention to maintaining glomerular filtration. Vancomycin is poorly removed by standard hemodialysis; hemofiltration and hemoperfusion may increase clearance. Contact the National Poison Control service (1-800-222-1222) in the US. (1) (2)
Frequently asked questions
Can I take oral vancomycin for a skin infection or pneumonia?
No. Oral vancomycin is poorly absorbed from the gut and acts locally; it is only for C. difficile-associated diarrhea and staphylococcal enterocolitis. Systemic infections like skin or lung infections require intravenous vancomycin administered in a healthcare setting. (2)
Why is the vancomycin infusion given so slowly?
Rapid IV infusion can cause a reaction called Red Man Syndrome—flushing, itching, wheezing, chest pain, and in severe cases low blood pressure, shock, or cardiac arrest. The minimum 60-minute infusion time helps reduce this risk. (1)
Will vancomycin affect my kidneys or hearing?
Vancomycin can cause kidney injury and hearing loss, especially with higher doses, longer treatment, older age, pre-existing hearing loss, or when used with other nephrotoxic or ototoxic drugs. Your kidney function, hearing, and vancomycin blood levels are monitored during treatment to help manage these risks. (1)
What is the mechanism of action of vancomycin hydrochloride?
Vancomycin is a glycopeptide antibiotic active against susceptible gram-positive bacteria. The intravenous formulation provides systemic treatment, while the oral formulation is poorly absorbed from the gastrointestinal tract and acts locally for C. difficile-associated diarrhea and staphylococcal enterocolitis. (1) (2)
References
- VANCOMYCIN HYDROCHLORIDE injection, solution — prescribing informationU.S. Food and Drug Administration · United States · accessed 2026-08-05 · source 1
- Vancomycin Hydrochloride for Oral Solution — drug information summaryU.S. Food and Drug Administration · United States · accessed 2026-08-05 · source 2
- VANCOMYCIN HYDROCHLORIDE CAPSULE [HERITAGE PHARMACEUTICALS INC. D/B/A AVET PHARMACEUTICALS INC.] — US prescribing information (DailyMed SPL)U.S. National Library of Medicine (DailyMed) · US · accessed 2026-08-14 · source 3
- Vancomycin — patient drug information (MedlinePlus)U.S. National Library of Medicine (MedlinePlus) · US · accessed 2026-08-14 · source 4
- Vancomycin Hydrochloride — FDA approval record (Drugs@FDA ANDA205694)U.S. Food and Drug Administration · US · accessed 2026-08-14 · source 5
- vancomycin — RxNorm normalized drug concept (RXCUI 11124)U.S. National Library of Medicine (RxNorm) · US · accessed 2026-08-14 · source 6
Brand names by country
Single-ingredient vancomycin hydrochloride names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.
Priority countries
United States
- TYZAVAN1.75 g/350mL, 1.5 g/300mL, 1.25 g/250mL, 2 g/400mL, 500 mg00mL, 750 mg50mL, 1 g/200mL · hikma pharmaceuticals usa inc.
- Vancocin125 mg, 250 mg · ani pharmaceuticals, inc.
Canada
- VAL-VANCOMYCIN
- VANCOCIN
- PMS-VANCOMYCIN 1 G