Vancomycin
A glycopeptide given intravenously for serious MRSA and other Gram-positive infections, and by mouth for C. difficile infection.
Drug card
- Class
- Glycopeptide
- How it works
- Binding the D-Ala-D-Ala ends of wall precursors so the cell wall cannot be built
- Used for
- MRSA infections of blood, skin, bone and lung
- C. difficile infection, by mouth
- Infective endocarditis
- Septicemia
- Known for
- Vancomycin infusion reaction (formerly red man syndrome)
- Acute kidney injury (interstitial nephritis)
- Hearing loss, tinnitus and vertigo
- Its name
- -mycin means an antibiotic from Streptomyces bacteria
Study it as a flashcard, and it comes back before you forget it.
Mechanism of action
How does vancomycin work?
Vancomycin grips the D-alanyl-D-alanine end of cell wall precursors so they cannot be added to peptidoglycan; it may also alter membrane permeability and RNA synthesis. It kills most Gram-positive bacteria, including MRSA, but only inhibits enterococci. Taken by mouth it is barely absorbed and acts in the gut.
Uses
What is vancomycin used for?
- MRSA infections of blood, skin, bone and lung
- C. difficile infection, by mouth
- Infective endocarditis
- Septicemia
- Bone infections
- Lower respiratory tract infections
Side effects
Side effects of vancomycin
- Vancomycin infusion reaction (formerly red man syndrome)Known for
- Acute kidney injury (interstitial nephritis)Known forSerious
- Hearing loss, tinnitus and vertigoKnown forSerious
- Low blood pressure and shock with rapid infusionSerious
- Wheezing and breathlessness during infusionSerious
- AnaphylaxisSerious
- Reversible neutropeniaSerious
- Severe skin reactions (SJS, TEN, DRESS, LABD)Serious
- Thrombophlebitis at the infusion site
- Nausea and abdominal pain (by mouth)
- Low potassium (by mouth)
- Retinal vasculitis and vision loss (eye injection)Serious
Known for marks what an exam expects you to know it for.
Watch for
Cautions and what sets it apart
- Infuse slowly, over at least 60 minutes, and before anesthetic induction where possible, to limit infusion reactions.
- Monitor blood vancomycin levels and kidney function; doses are adjusted in kidney impairment.
- Piperacillin/tazobactam, aminoglycosides and other nephrotoxic or ototoxic drugs add to the kidney and hearing risk.
- By mouth it treats only gut infections; given intravenously it does not treat C. difficile colitis.
Good to know: Labels now say vancomycin infusion reaction for the itchy flushing of face, neck and upper body that red man syndrome used to describe. For enterococcal endocarditis it is combined with an aminoglycoside.
Remember it
A way to remember it
NOT
- N
- Nephrotoxicity (acute kidney injury)
- O
- Ototoxicity
- T
- Thrombophlebitis at the infusion site
Vancomycin does NOT come trouble-free: watch the kidneys, the ears and the vein. Add the vancomycin infusion reaction if it is run in too fast.
A mnemonic widely used in teaching
Its name
-mycin means antibiotic from Streptomyces bacteria
Spans classes: macrolides (azithromycin), lincosamides (clindamycin), glycopeptides (vancomycin), aminoglycosides (streptomycin) and anticancer bleomycin. Gentamicin is spelled -micin.
- Every drug name stem
Its class
Glycopeptides
Glycopeptides bind the D-alanyl-D-alanine end of peptidoglycan precursors, at a different site from the one beta-lactams target, so the precursors cannot be built into the cell wall and the weakened wall lyses. They act on Gram-positive bacteria, including MRSA, while Gram-negative bacilli, mycobacteria and fungi resist them.
Easily mixed up with penicillins, oxazolidinones and lincosamides.
Sources
Checked against
Written for biofideX in plain words, after checking these references:
- Vancomycin hydrochloride for injection: label (DailyMed)
- Vancomycin hydrochloride capsules: label (DailyMed)
- Vancomycin (NCI Thesaurus)
- WHO Model List of Essential Medicines, 24th list (2025) (WHO)
For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.
Antibiotics: the cell wall
Vancomycin is one of 12 drugs practiced together here: their classes, how they work, what they treat and what they're known for.
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