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Vancomycin IV is an injectable antibiotic used for bacterial infections resistant to several other antibiotics 1. It is administered as a liquid through a vein, into the body, at a slow, controlled rate. Vancomycin IV is associated with some common and rare side effects, some of which resolve within a few days after discontinuation, and others that persist for longer periods 1. Patients should notify their physicians immediately if a side effect is experienced, as it could be life-threatening.

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Red Man Syndrome

"Red man syndrome" is a combination of fever, itching, chills, decreased blood pressure, increased heart rate and flushing, often accompanied by rashes on the face and upper body, that sometimes occurs when vancomycin IV is infused too fast 1. Micromedex recommends that vancomycin IV is infused over a minimum of 60 minutes 1. These symptoms usually disappear when the medication is stopped or the infusion rate is reduced. Pre-medication with antihistamines can help decrease the incidence of red man syndrome as well as relieve itching associated with the syndrome if it does occur.

Auditory (Hearing) Disturbances

Long-Term Side Effects of Vancomycin

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Vancomycin IV can affect hearing and this is usually characterized by fullness or ringing in the ears and difficulty hearing 1. The vancomycin medication package insert advises that prior to initiation of therapy, patients are screened for pre-existing hearing problems, and routine hearing monitoring should be maintained while on therapy 1. If there is any indication of compromised hearing, such as turning the volume of the television louder than usual or other signs of hearing difficulties, patients or caregivers should inform the physician immediately since hearing loss can be permanent.

Renal (Kidney) Compromise

Vancomycin IV is processed by the kidney 1. Patients with no fluid restrictions should maintain adequate fluid intake to "flush" the kidney and reduce the likelihood of overloading and damaging the organ. While on treatment, two kidney blood markers, BUN and creatinine, as well as vancomycin drug levels, are monitored in the blood 1. An increase in the levels of these markers correlates with a decline in kidney function, and a reduction in the dose is indicated to restore and preserve kidney function. Also, as kidney function declines, urine output decreases, causing dehydration and increase in thirst. Kidney function generally normalizes after vancomycin IV is discontinued 1.

Gastrointestinal (Stomach) Problems

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Nausea, vomiting, upset stomach, stomach cramps, stomach pains and diarrhea may occur. Diarrhea may be mild, in which case the doctor may not stop the medication, but it can also be excessive and bloody, warranting an immediate discontinuation. These side effects usually resolve once the medication is stopped.

Respiratory Difficulties

Wheezing , shortness of breath or difficulty breathing may occur while on vancomycin IV therapy, especially with the first dose 1. These symptoms can be an indication of an allergy to vancomycin, and the physician, infusion nurse or pharmacist should be notified at once 1.

Bleeding and Brusing

Vancomycin IV can also cause abnormal bleeding or bruising 1. It can also cause severe blistering on the skin, especially on the upper body including the arms and hands, as well as on the legs and feet. These side effects are rare, but life-threatening.