Vancomycin

These indications are based on manufacturer information for both originator and generic products. For product specific registered indications, please refer to product specific manufacturer information

Registered South African indications:

• Methicillin-resistant (ß-lactam-resistant) staphylococcal infections
• Serious staphylococcal infections in penicillin-allergic patients or patients who failed to respond to penicillin derivatives and/or cephalosporins
• Serious infections caused by vancomycin-sensitive organisms that are resistant to other antimicrobial agents, including penicillin derivatives and/or cephalosporins
• Staphylococcal endocarditis caused by S viridans or S.bovis (mono- or combination therapy)
• Endocarditis caused by enterococci such as E. faecalis (combination therapy)
• Staphylococcal enterocolitis and antibiotic-associated pseudomembranous colitis produced by C. difficile

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Vancomycin is indicated for initial therapy when methicillin-resistant staphylococci are suspected, however, once sensitivity data are available, therapy should be adjusted accordingly

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When staphylococcal infections are localized and purulent, antibiotics are used as adjuncts to appropriate surgical measures

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Vancomycin should not be administered intramuscularly due to the risk of necrosis at the site of administration

Cautions

• Pregnancy
• Breastfeeding
• Renal impairment
  - Anuria
• Elderly
• Obesity
• Previous/ underlying hearing loss
• Children (in particular, premature neonates and young infants)
• Prolonged use
• Teicoplanin sensitivity
• Monotherapy in non-Gram positive organism infections
• High blood concentrations
• Intracameral or intravitreal use
• Prophylaxis of endophthalmitis
• Patients with inflammatory disorders of the intestinal mucosa
• Oral use
• History of Stevens-Johnson syndrome (SJS)
• Irrational empirical vancomycin therapy
• Coadministration with agents that may cause neutropenia
• Coadministration with ototoxic agents, such as an aminoglycosides
• Coadministration with anaesthetic agents
• Coadministration with nephrotoxic agents (children)
• Coadministration with antimotility agents, such as proton pump inhibitors
• May impair ability to drive and operate machinery (negligible)

Forms avail. in SA and covered in this monograph: inj

Dosages below include:

• South African Standard Treatment Guidelines indications and dosages
• South African registered indications and dosages
• Indications and dosages registered in other jurisdictions

Infections caused by: Gram-positive organisms such as Enterococcus faecalis, Staphylococcus aureus, Methicillin-resistant Staphylococcus aureus, coagulase-negative Staphylococci, Streptococcus spp., Streptococcus pneumoniae, Enterococcus spp., Staphylococcus spp.; Anaerobic species such as Clostridium spp. (except Clostridium innocuum), C. difficile, C. jeikeium, Eubacterium spp., Peptostreptococcus spp. Arcanobacter. sp, E. faecalis (S), S. aureus MRSA, S. epidermidis (R), Staph coag-neg (R), Viridans Strep.

Specific doses based on individual indications

Please note that the dosages below should be used in combination with regional guidelines, taking into account local antibiotic sensitivities

South African Standard Treatment Guidelines indications and dosages

Clostridium difficile (C. difficile) diarrhoea - severe
Fulminant C. difficile diarrhoea (Additional agent required)
- If ileus or toxic megacolon or hypotension/shock
Recurrence of C. difficile diarrhoea
- If metronidazole was used during the first episode

• Oral (inj): 125mg, 6hrly; Treatment duration: 10 days
  (STG, Adult 2019)

Recurrence of C. difficile diarrhoea
- If vancomycin was used during the first episode

• Oral (inj): 125mg, 6hrly for 10 days; Then: 12hrly for 7 days; Then: dly for 7 days; Then every 2nd or 3rd day for 2-8 weeks
  (STG, Adult 2019)

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Give parenteral formulation orally

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Infective endocarditis
- Severe penicillin-allergic patients, or methicillin-resistant staphylococcal infections
- Empiric therapy for prosthetic valve (Additional agent required)
- Native valve fully penicillin-resistant streptococcal infections (Additional agent required)

• IV: 20mg/kg, 12hrly; Treatment duration: 6 weeks
  (STG, Adult 2019)

- Staphylococcal (cloxacillin/methicillin-resistant) or methicillin-sensitive with significant beta-lactam allergy

• IV: 20mg/kg, 12hrly; Treatment duration: 4 weeks
  (STG, Adult 2019)

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All cases of prosthetic valve endocarditis should be referred

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Aminoglycoside therapy should be monitored with trough levels for safety. Duration of therapy given is the minimum and may be extended based on the response (clinical and laboratory)

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For severe penicillin-allergic patients, or methicillin-resistant staphylococcal infections, it is essential to monitor trough concentrations of vancomycin regularly and adjust doses accordingly, starting after the third dose

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Febrile neutropenia (Additional agents required)
- If IV line, skin infection is suspected as the cause
Staphylococcus aureus (S. aureus) intravascular catheter infections

• IV: Loading dose: 30mg/kg; Maintenance: 20mg/kg, 12hrly: Treatment duration: 48-72hrs after resolution of fever except for confirmed S. aureus infection, and candidaemia, for these continue for 2 weeks after the 1st negative blood culture 
  (STG, Adult 2019)

Methicillin-resistant S. aureus surgical wound infections

• IV: Loading dose: 30mg/kg; Maintenance: 20mg/kg, 12hrly: Treatment duration: ≤7 days 
  (STG, Adult 2019)

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For intravascular catheter infections tailor therapy to drug-susceptibility results

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Post-surgical endophthalmitis (Additional agent required)
Endogenous endophthalmitis (Additional agent required)

• Intravitreal (inj): 1mg (consult specialist)
  (STG, Adult 2019)

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See additional prescribing points

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South African registered indications and dosages

Methicillin-resistant (ß-lactam-resistant) staphylococcal infections
Serious staphylococcal infections in penicillin-allergic patients or patients who failed to respond to penicillin derivatives and /or cephalosporins
Serious infections caused by vancomycin-sensitive organisms that are resistant to other antimicrobial agents, including penicillin derivatives and/or cephalosporins
Staphylococcal endocarditis caused by S viridans or S.bovis  (mono- or combination therapy)
Endocarditis caused by enterococci such as E. faecalis (combination therapy)

• IV: 2g, in divided doses, as either 500mg, 6hrly OR 1g, 12hrly

Treatment of staphylococcal enterocolitis
Antibiotic-associated pseudomembranous colitis produced by C. difficile 

• Oral (inj): 500mg-2000mg, in 3-4 divided doses; Treatment duration: 7-10 days; Max: 2g/24hrs

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The parenteral form of vancomycin may be administered orally for treatment of staphylococcal enterocolitis and antibiotic-associated pseudomembranous colitis produced by C. difficile. The parenteral administration of vancomycin alone is of unproven benefit for these indications. Vancomycin is not effective by the oral route for other types of infections

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The appropriate dose should be diluted in 30ml of water and given to the patient to drink. Common flavouring syrups should be added to the solution to disguise the taste for oral administration

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Indications and dosages registered in other jurisdictions

Complicated skin and soft tissue infections
- Non-necrotizing

• IV: 15-20mg/kg, 8-12hrly; Treatment duration: 7-14 days; Max single dose: 2g

- Necrotizing

• IV: 15-20mg/kg, 8-12hrly; Treatment duration: 4-6 weeks; Max single dose: 2g

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Continue until further debridement is not necessary, patient has clinically improved, and patient is afebrile for 48-72hrs

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Bone and joint infections

• IV: 15-20mg/kg, 8-12hrly; Treatment duration: 4-6 weeks; Max single dose: 2g

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Longer courses of oral suppression treatment with suitable antibiotics should be considered for prosthetic joint infections

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Community acquired pneumonia
Hospital acquired pneumonia
- Including ventilator-associated pneumonia

• IV: 15-20mg/kg, 8-12hrly; Treatment duration: 7-14 days; Max single dose: 2g

Infective endocarditis

• IV: 15-20mg/kg, 8-12hrly; Treatment duration: 4-6 weeks; Max single dose: 2g

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Duration and need for combination therapy is based on valve-type and organism

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All indications: The initial dose should be based on total body weight. Subsequent dose adjustments should be based on serum concentrations to achieve targeted therapeutic concentrations. Renal function must be taken into consideration for subsequent doses and interval of administration

In any case, the duration of treatment should be tailored to the type and severity of infection and the individual clinical response

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All indications: In seriously ill patients, a loading dose of 25–30mg/kg of body weight can be used to facilitate rapid attainment of target trough serum vancomycin concentration

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Peri-operative prophylaxis of bacterial endocarditis
- In patients that are at high risk of developing bacterial endocarditis when undergoing major surgical procedures

• IV: 15mg/kg, prior to induction of anaesthesia; Depending on the duration of surgery, a 2nd dose may be required

Clostridium difficile infection (CDI)
- First episode of non-severe CDI

• Oral (inj): 125mg, 6hrly; Treatment duration: 10 days; Max: 2g/24hrs

- Severe or complicated disease

• Oral (inj): 500mg, 6hrly; Treatment duration: 10 days; Max: 2g/24hrs

-  Multiple recurrences

• Oral (inj): 125mg, 6hrly; Treatment duration: 10 days; Then: down-titrate gradually until 125mg, dly OR use pulse regimen of 125-500mg/day every 2-3 days for ≥3 weeks

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Treatment duration with vancomycin may need to be tailored to the clinical course of individual patients. Whenever possible the antibacterial suspected to have caused CDI should be discontinued. Adequate replacement of fluid and electrolytes should be ensured

Paed. forms avail. in SA and covered in this monograph: inj

Dosages below include:

• General dosing range
• South African Standard Treatment Guidelines indications and dosages
• South African registered indications and dosages
• Indications and dosages registered in other jurisdictions

Infections caused by: Gram-positive organisms such as Enterococcus faecalis, Staphylococcus aureus (S. aureus), Methicillin-resistant Staphylococcus aureus, coagulase-negative Staphylococci, Streptococcus spp., Streptococcus pneumoniae, Enterococcus spp., Staphylococcus spp.; Anaerobic species such as Clostridium spp. (except Clostridium innocuum), C. difficile, C. jeikeium, Eubacterium spp., Peptostreptococcus spp. Arcanobacter. sp, E. faecalis (S), S. aureus MRSA, S. epidermidis (R), Staph coag-neg (R), Viridans Strep.

General dosing range

28 days and younger

• No information available

Older than 28 days

• IV: 60-80mg/kg divided in 3-4 doses, to achieve target AUC (24hrs) of 400-600μg/ml x hr

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See additional prescribing points

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Specific doses based on individual indications

Please note that the dosages below should be used in combination with regional guidelines, taking into account local antibiotic sensitivities

South African Standard Treatment Guidelines indications and dosages

Methicillin-resistant Staphylococcus aureus (MRSA) burns (suspected or confirmed) (Additional agent required)

• IV: 15mg/kg, 6hrly; Treatment duration: 5–14 days
  (STG, Paed. 2017) 

Acute bacterial meningitis - shunt-associated (Additional agents required)
Methicillin-resistant Staphylococcal septicaemia (suspected or confirmed) 
MRSA nosocomial pneumonia 

• IV: 15mg/kg, 6hrly infused over 1hr
  (STG, Paed. 2017; Paed. 2023) 

MRSA pneumonia 

• IV: 15mg/kg, 6hrly infused over 1hr; Treatment duration: 14 days 
  (STG, Paed. 2023) 

MRSA septic pyogenic arthritis (Additional agent required)
MRSA acute osteomyelitis/osteitis (Additional agent required)

• IV: 15mg/kg, 6hrly infused over 1hr; Treatment duration: 4-6 weeks minimum
  (STG, Paed. 2017)

Gram-positive infections in patients with penicillin allergy

• IV: 15mg/kg, 8hrly infused over 1hr
  (STG, Paed. 2023)

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Give parenteral formulation orally

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South African registered indications and dosages

Methicillin-resistant (ß-lactam-resistant) staphylococcal infections
Serious staphylococcal infections in penicillin-allergic patients or patients who failed to respond to penicillin derivatives and /or cephalosporins
Serious infections caused by vancomycin-sensitive organisms that are resistant to other antimicrobial agents, including penicillin derivatives and/or cephalosporins
Staphylococcal endocarditis caused by S viridans or S.bovis  (mono- or combination therapy)
Endocarditis caused by enterococci such as E. faecalis (combination therapy)

Younger than 7 days (in the first week of life)

• IV: Initial dose: 15mg/kg; Then: 10mg/kg, 12hrly, at a rate ≤500mg/30min

Between 8 days and 1 month

• IV: Initial dose: 15mg/kg; Then: 10mg/kg, 8hrly; Administer at a rate ≤500mg/30min

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Close monitoring of serum vancomycin concentration is warranted

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Children 

• IV: 40mg/kg/day, in divided doses; Incorporate into the child’s 24-hour fluid requirement

Treatment of staphylococcal enterocolitis
Antibiotic-associated pseudomembranous colitis produced by C. difficile 

• Oral (inj): 40mg/kg/day, in 3-4 divided doses; Treatment duration: 7-10 days; Max: 2g/24hrs

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The parenteral form of vancomycin may be administered orally for treatment of staphylococcal enterocolitis and antibiotic-associated pseudomembranous colitis produced by C. difficile. The parenteral administration of vancomycin alone is of unproven benefit for these indications. Vancomycin is not effective by the oral route for other types of infections

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The appropriate dose should be diluted in 30ml of water and given to the patient to drink. Common flavouring syrups should be added to the solution to disguise the taste for oral administration

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Indications and dosages registered in other jurisdictions

Community-acquired pneumonia
Hospital-acquired pneumonia
- Including ventilator-associated pneumonia
Complicated skin and soft tissue infections
- Non-necrotizing

Birth - 27 days (including preterm neonates)

• For establishing the dosing regimen for neonates, the advice of a physician experienced in the management of neonates should be sought. One possible way of dosing vancomycin in neonates is illustrated in the table below:

*PMA (weeks)	Dose/ Interval of administration	Treatment duration
<29	15mg/kg, 24hrly	7-14 days
29-35	15mg/kg, 12hrly	7-14 days
>35	15mg/kg, 8hrly	7-14 days

*PMA: post-menstrual age [(time elapsed between the first day of the last menstrual period and birth (gestational age) plus the time elapsed after birth (post-natal age)]

Between 1 month - <12 years

• IV: 10-15mg/kg, 6hrly; Treatment duration; 7-14 days

12 years and older

• IV: See adult dosage

Complicated skin and soft tissue infections
- Necrotizing
Bone and joint infections
Infective endocarditis

Birth - 27 days (including preterm neonates)

• For establishing the dosing regimen for neonates, the advice of a physician experienced in the management of neonates should be sought. One possible way of dosing vancomycin in neonates is illustrated in the table below:

*PMA (weeks)	Dose/ Interval of administration	Treatment duration
<29	15mg/kg, 24hrly	4-6 weeks
29-35	15mg/kg, 12hrly	4-6 weeks
>35	15mg/kg, 8hrly	4-6 weeks

*PMA: post-menstrual age [(time elapsed between the first day of the last menstrual period and birth (gestational age) plus the time elapsed after birth (post-natal age)]

Between 1 month - <12 years

• IV: 10-15mg/kg, 6hrly; Treatment duration: 4-6 weeks

12 years and older

• IV: See adult dosage

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Complicated skin and soft tissue infections (necrotizing): Continue until further debridement is not necessary, patient has clinically improved, and the patient is afebrile for 48-72hrs

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Bone and joint infections: Longer courses of oral suppression treatment with suitable antibiotics should be considered for prosthetic joint infections

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Infective endocarditis: Duration and need for combination therapy is based on valve-type and organism

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Clostridium difficile infection (CDI)

Neonates, infants and children <12 years old

• Oral (inj): 10mg/kg, 6hrly; Treatment duration: 10 days: Max: 2g/24hrs

12 years and older

• Oral (inj): See adult dosage

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Treatment duration with vancomycin may need to be tailored to the clinical course of individual patients. Whenever possible the antibacterial suspected to have caused CDI should be discontinued. Adequate replacement of fluid and electrolytes should be ensured

Pregnancy

• Caution; no evidence of risk in studies
• Teratology studies have been performed at 5 times the human dose in rats and 3 times the human dose in rabbits, and have revealed no evidence of harm to the foetus due to vancomycin. In a controlled clinical study, the potential ototoxic and nephrotoxic effects of vancomycin hydrochloride on infants were evaluated when the drug was administered to pregnant women for serious staphylococcal infections complicating intravenous drug abuse. Vancomycin hydrochloride was found in cord blood. No sensorineural hearing loss or nephrotoxicity attributable to vancomycin was noted. One infant, whose mother received vancomycin in the third trimester, experienced conductive hearing loss that was not attributable to vancomycin. Because vancomycin was administered only in the second and third trimesters, it is not known whether it causes foetal harm. Vancomycin should be given during pregnancy only if clearly needed and blood levels should be monitored carefully to minimise the risk of foetal toxicity. It has been reported, however, that pregnant patients may require significantly increased doses of vancomycin to achieve therapeutic serum concentrations

Breastfeeding

• Caution; not recommended
• Vancomycin hydrochloride is excreted in human milk. Caution should be exercised when vancomycin is administered to a breastfeeding woman. It is unlikely that a breastfed infant can absorb a significant amount of vancomycin from its gastrointestinal tract

Renal Impairment

• Caution; dose adjustment recommended
• Vancomycin dosing is based on actual 'total' body weight and calculated renal function
  All patients should receive a loading dose of 25-30mg/kg
  All maintenance (subsequent) doses should be calculated according to vancomycin plasma trough-concentrations levels
  Dosing interval adjustment (not of doses) is recommended and must be measured based on the patient's renal function and drug trough levels

eGFR (ml/min/1.73m2)	Dosing Interval
≥80	12hrly
≥50-79	24hrly
≥35-49	36hrly
≥25-34	48hrly
<25 or on dialysis	Only dose when trough levels are below 15mcg/mL (measuring unit may vary from laboratory service provider to another )

Paediatric-specific recommendations

• Dose adjustments in paediatric patients aged 1 year and older could be based on glomerular filtration rate estimated
  (eGFR) by the revised Schwartz formula
• For neonates and infants below 1 year of age, expert advice should be sought as the revised Schwartz formula is not
  applicable to them

GFR (ml/min/1.73m2)	Dose and Frequency
50-30	15mg/kg, 12hrly
29-10	15mg/kg, 24hrly
<10	10-15mg/kg; Re-dose based on levels*
Intermittent haemodialysis
Peritoneal dialysis
Continuous renal replacement therapy	15mg/kg; Re-dose based on levels*

The appropriate timing and amount of subsequent doses largely depends on the modality of renal replacement therapy and should be based on serum vancomycin levels obtained prior to dosing and on residual renal function. Depending on the clinical situation, consideration could be given to withhold the next dose while awaiting the results of vancomycin levels

Hepatic Impairment

• No dose adjustment recommended

Elderly

• Caution; no dose adjustment recommended
  Lower maintenance doses may be required due to the age-related reduction in renal function

Obesity

• Caution; no dose adjustment recommended
• Initial dose should be individually adapted according to total body weight as in non-obese patients

Porphyria Information

• Not porphyrinogenic (NP)

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Dizziness

Cardiovascular Disorders

• Cardiac arrest
• Decreased blood pressure
• Vasculitis
• Exaggerated hypotension
• Shock
• Thrombophlebitis

Respiratory Disorders

• Dyspnoea
• Stridor

Gastrointestinal Disorders

• Pseudomembranous colitis
• Nausea and vomiting
• Diarrhoea

Genitourinary Disorders

• Acute renal failure
• Acute tubular necrosis
• Renal insufficiency
• Increased serum creatinine
• Increased serum urea concentrations
• Interstitial nephritis

Musculoskeletal Disorders

• Pain and muscle spasm of the chest and back muscles

Skin and Subcutaneous Tissue Disorders

• Flushing of the upper body ("Red man syndrome")
• Red neck syndrome
• Exanthema
• Mucosal inflammation
• Pruritus
• Urticaria
• Exfoliative dermatitis
• Stevens-Johnson syndrome
• Toxic epidermal necrolysis
• Linear IgA bullous dermatosis
• Drug rash with eosinophilia and systemic symptoms
• Acute generalized exanthematous pustulosis
• Phlebitis
• Maculopapular rash 
• Erythematous rash 

Immune, Blood and Lymphatic System Disorders

• Reversible neutropenia
• Eosinophilia
• Thrombocytopenia
• Agranulocytosis
• Pancytopenia
• Hypersensitivity reactions
• Anaphylactic reactions
• Drug fever
• Shivering
• Infusion-related reactions
  - Hypotension
  - Flushing
  - Erythema
  - Urticaria
  - Pruritus
• Overgrowth of non-susceptible organisms

Sensory Disorders

• Transient/ permanent hearing loss
• Tinnitus
• Ototoxicity
• Vertigo
• Hemorrhagic occlusive retinal vasculitis (HORV)
• Permanent loss of vision

Others

• Pain

• Neurotoxic agents
• Amphotericin B
• Aminoglycosides
• Piperacillin/ tazobactam
• Bacitracin
• Polymixin B
• Colistin
• Viomycin
• Cisplatin
• Loop diuretics

• Periodic haematologic examination
• Urine analysis
• Renal function

Specific cases may require

• Full blood count
• Leukocyte count
• Vestibular and auditory function
• Cardiac monitoring
• Vancomycin levels

Monitoring of vancomycin serum concentrations

• The frequency of therapeutic drug monitoring (TDM) needs to be individualised based on the clinical situation and response to treatment, ranging from daily sampling that may be required in some hemodynamically unstable patients to at least once weekly in stable patients showing a treatment response
• In patients with normal renal function, the serum concentration of vancomycin should be monitored on the second day of treatment immediately prior to the next dose
• In patients on intermittent haemodialysis, vancomycin levels should be usually obtained before the start of the haemodialysis session
• After oral administration, monitoring vancomycin serum concentrations in patients with inflammatory intestinal disorders should be performed Therapeutic trough (minimum) vancomycin blood levels should normally be 10-20mg/l, depending on the site of infection and susceptibility of the pathogen
• Trough values of 15-20mg/l are usually recommended by clinical laboratories to better cover susceptible-classified pathogens with MIC ≥1mg/L
• Model-based methods may be useful in the prediction of individual dose requirements to reach an adequate AUC
• The model-based approach can be used both in calculating the personalized starting dose and for dose adjustments based on TDM results

Administration directions

• DO NOT administer as IM or IV bolus
• The efficacy and safety of vancomycin has not been established for the intrathecal, intralumbar and intraventricular routes of administration

- Intravenous administration

• IV vancomycin is usually administered as an intermittent infusion and the dosing recommendations presented in this section for the intravenous route correspond to this type of administration
• Vancomycin shall only be administered as slow IV infusion of at least 1 hour duration or at a maximum rate of 10mg/min (whichever is longer) which is sufficiently diluted (at least 100ml per 500mg or at least 200ml per 1000mg)
• Patients whose fluid intake must be limited can also receive a solution of 500mg/50 ml or 1000mg/100ml, although the risk of infusion-related undesirable effects can be increased with these higher concentrations
• Continuous vancomycin infusion may be considered, e.g., in patients with unstable vancomycin clearance

- Oral administration

• The contents of vials for parenteral administration may be used
• Each dose may be reconstituted in 30ml water and either given to the patient to drink, or administered by nasogastric tube
• Common flavouring syrups may be added to the solution at the time of administration to improve the taste

Oral administration

• IV administration of vancomycin is not effective for the treatment of Clostridium difficile infection
• Vancomycin should be administered orally for this indication
• Testing for Clostridium difficile colonization or toxin is not recommended in children younger than 1 year due to high rate of asymptomatic colonisation unless severe diarrhoea is present in infants with risk factors for stasis such as Hirschsprung disease, operated anal atresia or other severe motility disorders. Alternative aetiologies should always be sought and Clostridium difficile enterocolitis be proven

Vancomycin is a tricyclic glycopeptide antibiotic that inhibits the synthesis of the cell wall in sensitive bacteria by binding with high affinity to the D-alanyl-D-alanine terminus of cell wall precursor units. The drug is slowly bactericidal for dividing microorganisms. In addition, it impairs the permeability of the bacterial cell membrane and RNA synthesis.

Spectrum of activity: Gram-positive organisms such as Enterococcus faecalis, Staphylococcus aureus, Methicillin-resistant Staphylococcus aureus, coagulase-negative Staphylococci, Streptococcus spp., Streptococcus pneumoniae, Enterococcus spp., Staphylococcus spp.; Anaerobic species such as Clostridium spp. (except Clostridium innocuum), C. difficile, C. jeikeium,Eubacterium spp., Peptostreptococcus spp. Arcanobacter. sp, E. faecalis (S), S. aureus MRSA, S. epidermidis (R), Staph coag-neg (R), Viridans Strep.

Injection (per vial) 500mg

• Aspen Vancomycin CP (Pharmacare)
• Gulf Vancomycin (Gulf Drug) 
• Mylan Vancomycin (Mylan)
• Vancocin CP (Sandoz)
• Vancomycin-Faulding (Pharmaplan)

Injection (per vial) 1g

• Aspen Vancomycin CP (Pharmacare)
• Gulf Vancomycin (Gulf Drug) 
• Mylan Vancomycin (Mylan)
• Vancomycin-Faulding (Pharmaplan)
• Vancocin CP (Sandoz)