In this episode, I’ll discuss whether it is ever appropriate for a patient to be on oral and IV vancomycin.
While IV vancomycin is indicated to treat a variety of infectious diseases, oral vancomycin is primarily used to treat C diff infection (CDI).
Unlike IV metronidazole, which achieves therapeutic levels in the colon when inflammation is present, vancomycin does not reach the colon when given intravenously.
It is for that reason that oral vancomycin is used, especially when treating severe and fulminant C diff.
As C diff is often a complication of antibiotic therapy, it is entirely possible for a patient who develops C diff to be placed on IV vancomycin to treat a previous infection such as endocarditis, cellulitis, or pneumonia.
When a pharmacist receives an order for an oral antibiotic that a patient is already receiving IV, in nearly all cases the intent to discontinue the IV antibiotic is assumed.
However with vancomycin, the IV and oral forms are always used to treat different infections, and it is not appropriate to discontinue IV vancomycin upon receipt of an oral vancomycin order.
New clinicians, especially those new to hospital practice should have education provided on why IV and oral vancomycin may be given together, and pharmacists monitoring such patients should be on the lookout for such a scenario to prevent a patient with endocarditis or other serious infection having their treatment unintentionally stopped.
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TDM of vancomycin is suggested when oral and IV form used together, because inflammatory colon might absorb additional vancomycin into blood. What do you think, Joe?