Vancomycin..first choice drug??

[lsyorke]

Is it only me or are others seeing patients being put on Vancomycin as a first choice antibiotic? I've seen little old men with uti's, not septic, just a low grade fever and dehydration, put on Vancomycin right off the bat. Talk about creating the "superbig". And what are we doing to these people kidneys? Anyone else see this?

[Altra, BSN, RN]

hospitals in oahu hawaii are using vancomycin routinely as a prophylaxis antibiotic for prevention of infection without informing the patient is this ethical or a violation of patient rights?"

why would this be a violation of the patient's rights? what "rights" are being violated by the use of vanco?

[ZippyGBR, BSN, RN]

UTI what the hell happened to trimethoprim / co-amoxiclav / cefwhatever.... that's whats in our rightpaondian formularly as first to second lines then add gent or go to an AMG type regime if they don't work

[kandycane]

Why would this be a violation of the patient's rights? What "rights" are being violated by the use of Vanco?

vanco is ototoxic you should tell the patient and check history of patients rental and hearing. Before administering any medication we are to ask the patient if they are allergic to the drug. If we don't disclose the use of vanco on patients for prophylaxis use on a healthly patient is it going to work if they get staph and really did need vanco?

I am a student only but according to my books this is wrong........

[woody62, RN]

A year ago I was admitted to ICU in septic shock, when a wound developed an infection four weeks after an I & D. I was put on Vancomycin but I am also allergic to penicillin. I would be nervous if the hospital I used, in the community I lived, put everyone on this drug. I would be more afraid of my grandchildren developing a Vancomycin resistant infection. And I understand it is all ready happening with patients in the community being admitted with MRSA, who have never been hospitalized.

Woody:balloons:

[Levin]

The broad spectrum abx we use before knowing what actual bug there might be, if any, is zosyn and we use kefzol peri-operatively.

If a person is allergic to penicillins, then we use vanco as a broad spectrum.

? Why would you go from penecillin to vanco? That seems overly eager.

After penecillin, the next regime would typically be Erythromycin and Flagyl.

I could understand if he had raging sepis, in that case you don't have the time to play around finding out what works and what doesn't.

But for something non-emergent to go to Vanco as second option seems hasty. Do you have a rationale for it in your AB protocols, I assume your hospital has some reason for choosing to do that and I'm curious as to what it is.

Levin

[kandycane]

? why would you go from penecillin to vanco? that seems overly eager.

after penecillin, the next regime would typically be erythromycin and flagyl.

i could understand if he had raging sepis, in that case you don't have the time to play around finding out what works and what doesn't.

but for something non-emergent to go to vanco as second option seems hasty. do you have a rationale for it in your ab protocols, i assume your hospital has some reason for choosing to do that and i'm curious as to what it is.

levin

i am a new student, and have not lived here long. when i asked…. staff says one gram vanco will not hurt anyone. we give it all the time. healthy in patients that come in for minor surgery receive it. i question the lack of informing the patient. they also infuse 15minutes before surgery…. hawaii is common for staph, but this is not the answer.

kandycane

[Altra, BSN, RN]

vanco is ototoxic you should tell the patient and check history of patients rental and hearing. Before administering any medication we are to ask the patient if they are allergic to the drug. If we don't disclose the use of vanco on patients for prophylaxis use on a healthly patient is it going to work if they get staph and really did need vanco?

I am a student only but according to my books this is wrong........

There are reasons why Vanco (or any other med) may be ordered as the drug of choice in a particular situation. Yes, Vanco can be ototoxic, and like many abx is tough on the renal system. These are things to be considered by the prescriber and the nurse administering the meds, but you (incorrectly) present this as if it were some kind of experimental treatment with a high probability of harm to the patient, and that is simply not the case.

You posed the provocative question, "is this violating the patient's rights?" -- but did not answer when I sought clarification. What "rights" of the patient do you believe that administration of Vancomycin violates? Why is Vancomycin a special case, different from other drugs with profound effects on various body systems and the potential for adverse side effects?

Keep studying ...

[MadisonsMomRN, BSN, RN]

Cipro is usually our first drug of choice for UTI's. I have seen Vanco used for MRSA infections but thats it.

[pagandeva2000, LPN]

During clinicals and my first six week orientation in med-surg, I saw more vanco administered than I was comfortable with. Made me wonder if everyone was really that sick.

[kandycane]

During clinicals and my first six week orientation in med-surg, I saw more vanco administered than I was comfortable with. Made me wonder if everyone was really that sick.

Thanks, you and I know they aren't sick. But the preventions they are using to prevent infection is over kill. The overuse of vanco on healthy patients is just causing more health problems. Its the doctors ordering it and we can't do much about it . i have questioned it, but they act like its just water. A river of vanco runs through alot of these hospitals and the patient and public have no idea......:angryfire:angryfire:angryfire

[kandycane]

there are reasons why vanco (or any other med) may be ordered as the drug of choice in a particular situation. yes, vanco can be ototoxic, and like many abx is tough on the renal system. these are things to be considered by the prescriber and the nurse administering the meds, but you (incorrectly) present this as if it were some kind of experimental treatment with a high probability of harm to the patient, and that is simply not the case.

you posed the provocative question, "is this violating the patient's rights?" -- but did not answer when i sought clarification. what "rights" of the patient do you believe that administration of vancomycin violates? why is vancomycin a special case, different from other drugs with profound effects on various body systems and the potential for adverse side effects?

keep studying ...

jcaho medication management standards

uses vanco as an example of medication to inform patient of.

i have been studying.

these verifications must occur at the time of administration in the location where the drug is being administered, as much as possible.

the patient or, if appropriate, the patient's family should be advised about any potential significant adverse reactions or other concerns about administering a medication before it is administered. for example, a patient receiving vancomycin might be warned about red man syndrome. this information allows the patient to self-monitor for such a reaction.:angryfire

the nurse or person administering the drug should discuss any unresolved, significant concerns about the medication with the patient's physician, prescriber (if different from the physician), or relevant staff involved in the patient's care. this discussion should occur before medication administration.

kandycane

[BBFRN, BSN, PhD]

One I forgot about, we actually still use a lot of IV Cipro for our urosepsis...seems as though it fell by the wayside for a bit, but is back again

yes- I think it fell by the wayside during the Anthrax scare, because the prices shot up. It almost became too expensive to use for UTIs, so I guess other ABTs replaced it in the hospital formularies.