Vancomycin is a powerful glycopeptide antibiotic reserved for treating serious bacterial infections, particularly those resistant to other antibiotics like penicillin [1.3.2, 1.5.5]. Its use is carefully managed to prevent the rise of vancomycin-resistant bacteria [1.4.4]. Vancomycin works by inhibiting the formation of the bacterial cell wall, which ultimately leads to bacterial cell death [1.4.5, 1.6.1]. It is not effective against viral infections like the common cold or flu [1.2.1].
Administration Routes and Their Targets
How vancomycin is given to a patient—orally or intravenously (IV)—determines which symptoms and infections it can treat. These two forms are not interchangeable [1.5.5].
Oral Vancomycin
When taken by mouth, vancomycin is poorly absorbed into the bloodstream. This quality makes it highly effective for treating infections localized in the gut [1.4.5, 1.5.6].
Symptoms & Infections Treated by Oral Vancomycin:
- Clostridioides difficile-Associated Diarrhea (CDAD): This is the primary use for oral vancomycin [1.2.3]. C. diff is a bacterium that can cause life-threatening colitis (inflammation of the colon), with symptoms including severe, watery diarrhea and abdominal cramps [1.2.3, 1.4.3]. Vancomycin is considered a first-line treatment for severe C. diff infections [1.4.6].
- Staphylococcal Enterocolitis: This is an inflammation of the small intestine and colon caused by Staphylococcus aureus bacteria, and oral vancomycin is an approved treatment [1.2.2, 1.4.3].
Intravenous (IV) Vancomycin
For infections outside the gut, vancomycin must be administered directly into a vein (intravenously) [1.5.6]. This allows the drug to circulate throughout the body and treat systemic and deep-seated bacterial infections [1.5.3].
Symptoms & Infections Treated by IV Vancomycin:
- Methicillin-resistant Staphylococcus aureus (MRSA): IV vancomycin is a go-to treatment for serious MRSA infections [1.4.4]. These can manifest as skin infections, bloodstream infections (septicemia), pneumonia, or bone infections [1.3.2, 1.3.5].
- Infective Endocarditis: This is a serious infection of the heart's inner lining or valves, often caused by staphylococcal, streptococcal, or enterococcal bacteria [1.2.2, 1.3.2].
- Septicemia (Sepsis): A life-threatening bloodstream infection [1.3.5].
- Bone Infections (Osteomyelitis): Bacterial infection within a bone [1.3.2, 1.5.2].
- Lower Respiratory Tract Infections: Such as severe pneumonia caused by susceptible bacteria [1.3.2].
- Skin and Skin Structure Infections: Used for complicated or severe skin infections that are not treatable by other antibiotics [1.3.2].
Comparison of Vancomycin Administration Routes
| Feature | Oral Vancomycin | Intravenous (IV) Vancomycin |
|---|---|---|
| Primary Use | C. difficile-associated diarrhea, Staphylococcal enterocolitis [1.2.3, 1.2.5] | Systemic infections like MRSA, sepsis, endocarditis [1.3.2, 1.4.1] |
| Absorption | Poorly absorbed; stays in the gut [1.4.1] | Directly enters the bloodstream for wide distribution [1.5.6] |
| Target Area | Intestines/Colon [1.2.3] | Throughout the body (blood, bones, lungs, heart, skin) [1.3.2] |
| Common Side Effects | Nausea, abdominal pain, gas [1.2.6, 1.6.5] | Kidney damage (nephrotoxicity), hearing loss (ototoxicity), Vancomycin Flushing Syndrome [1.6.2, 1.6.6] |
Potential Side Effects and Monitoring
Vancomycin is a strong medication that can have significant side effects. Patient monitoring is crucial, especially with IV administration.
- Nephrotoxicity (Kidney Damage): Vancomycin can be hard on the kidneys. The risk increases with high doses, prolonged use, and in elderly patients or those with pre-existing kidney problems [1.2.5, 1.6.6]. Kidney function is regularly monitored through blood tests [1.3.4].
- Ototoxicity (Hearing Damage): In rare cases, vancomycin can damage hearing, potentially leading to ringing in the ears (tinnitus) or hearing loss. This risk is higher with excessive doses or in patients with kidney impairment [1.6.5, 1.6.6].
- Vancomycin Flushing Syndrome: Previously known as "red man syndrome," this reaction is associated with rapid IV infusion. Symptoms include flushing, itching, and an erythematous rash on the face, neck, and upper body [1.6.6]. To prevent this, vancomycin is infused slowly, typically over at least 60 minutes [1.3.4].
- Gastrointestinal Issues: Common side effects of the oral form include nausea, vomiting, and stomach pain [1.3.3].
Conclusion
Vancomycin is a critical antibiotic for treating specific and often severe bacterial infections. The symptoms it treats depend entirely on how it is administered. Oral vancomycin is exclusively for intestinal infections like C. difficile-associated diarrhea, where its poor absorption is an advantage. In contrast, IV vancomycin is a cornerstone for fighting life-threatening systemic infections such as MRSA, sepsis, and endocarditis. Due to its potential for serious side effects, its use requires careful medical supervision and monitoring.
For more information, consult resources like the U.S. National Library of Medicine's page on Vancomycin Injection.
