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Time Completed: 01:08:33

Final Score 46%

83
97

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Pharmacology

Infections

Question 14 of 180

Vancomycin is most likely indicated for which of the following infections:

Answer:

Oral vancomycin is used second line for refractory or severe cases of pseudomembranous colitis caused by Clostridium difficile colitis.

Vancomycin

Mechanism of Action

Vancomycin is a glycopeptide antibiotic which acts by inhibiting peptidoglycan formation and is active against aerobic and anaerobic Gram-positive bacteria including multi resistant staphylococci.

Vancomycin binds to the terminal end of the growing peptidoglycan to prevent further elongation and cross-linking due to inhibition of transglycosylase; this results in decreased cell membrane activity and increased cell lysis.

For systemic infection vancomycin must be given by intravenous injection as it is not absorbed orally. Penetration into cerebrospinal fluid is poor. It is given orally for pseudomembranous colitis caused by Clostridium difficile infection.

Indications

Indications include:

  • C. difficile colitis
  • Infections due to Gram-positive bacteria including endocarditis, osteomyelitis, septicaemia, pneumonia, septic arthritis and soft-tissue infection where MRSA is suspected/demonstrated
  • Peritonitis associated with peritoneal dialysis
  • Septicaemia related to vascular catheter
  • Surgical prophylaxis (when high risk of MRSA)

Cautions

Vancomycin should be avoided if there is a history of deafness, and should be used with caution in the elderly. The dose should be reduced in renal impairment, and the plasma-vancomycin, renal function and auditory function monitored regularly.

Side Effects

Side effects include:

  • Blood disorders including neutropenia
  • Nephrotoxicity (acute interstitial nephritis)
  • Ototoxicity (discontinue if tinnitus occurs)
  • Rarely anaphylactoid reaction, cardiac arrest or 'red man' syndrome (flushing of the upper body) on rapid infusion

Monitoring

All patients require plasma-vancomycin measurement (after 3 or 4 doses if renal function normal, earlier if renal impairment).

All patients require blood counts, urinalysis, and renal function tests. Auditory function should be monitored in the elderly.

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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