반코마이신

글리코펩타이드계 항생제

**반코마이신(Vancomycin)**은 강력한 살균성 글리코펩타이드계 항생제로, 인의 및 수의학 모두에서 전통적으로 '최후의 보루'로 여겨지는 약물입니다. * **임상적 역할:** **메티실린 내성 황색포도상구균(MRSA)**, **메티실린 내성 위중간포도상구균(MRSP)** 및 다제내성 장구균과 같은 다제내성 그람 양성균에 의한 심각하고 생명을 위협하는 감염에 엄격히 제한되어 사용됩니다. * **투여 방법:** 전신 감염의 경우 **반드시** 느린 정맥내(IV) 주입으로 투여해야 합니다. 심각한 조직 괴사 및 통증을 유발하므로 피하(SC) 또는 근육내(IM) 주사는 절대 금기입니다. * **경구 사용:** 반코마이신은 위장관을 통해 흡수되지 않으므로, 경구 투여는 **클로스트리디움 디피실(*C. difficile*)에 의한 위막성 대장염**과 같은 심각한 국소 장 감염을 치료하는 데에만 독점적으로 사용됩니다. > **임상 진주:** 인간의 치명적인 감염 치료에서 반코마이신의 중요성 때문에 수의학에서의 사용은 논란의 여지가 많으며, 배양 및 감수성 검사에서 다른 항생제 대안이 없음을 확인할 때만 사용을 고려해야 합니다.

작용 기전: Vancomycin exerts its bactericidal effect primarily by inhibiting bacterial cell wall synthesis. * **Target Binding:** It binds tightly and non-covalently to the **D-alanyl-D-alanine** terminus of cell wall precursor units. * **Inhibition:** This massive steric hindrance prevents the enzymes (transglycosylases and transpeptidases) from incorporating the precursors into the growing peptidoglycan matrix → **inhibition of cell wall cross-linking**. * **Secondary Mechanisms:** It also alters bacterial cell-membrane permeability and interferes with RNA synthesis, making resistance more difficult to develop. * **Spectrum:** Activity is strictly limited to **gram-positive** organisms (staphylococci, streptococci, enterococci, *Clostridium*, *Listeria*). It is bactericidal against most susceptible bacteria but generally bacteriostatic against enterococci.

동물 종별 용량

Cats

Confirmed bacteremia/septicemia for enterococci or staphylococci resistant to other commonly used antibiotics · 15 mg/kg IV over 30-60 minutes · IV · q6-8h
Serious infections · 15 mg/kg IV over 30-60 minutes · IV · q6h · For successful therapy, an aminoglycoside such as gentamicin or amikacin should also be administered.

Dogs

Confirmed bacteremia/septicemia for enterococci or staphylococci resistant to other commonly used antibiotics · 15 mg/kg IV over 30-60 minutes · IV · q6-8h
Serious infections · 15 mg/kg IV over 30-60 minutes · IV · q6h · For successful therapy, an aminoglycoside such as gentamicin or amikacin should also be administered.
C. difficile enterocolitis · 10-20 mg/kg PO · PO · q6h · 5-7 days · Oral vancomycin is not appreciably absorbed and is only effective for susceptible enteric infections.
Skin, urinary, soft tissue infections · 10-20 mg/kg IV · IV · q12h · 7-10 days
Systemic infections, bacteremia · 15 mg/kg IV · IV · q6h · 10 days

용량은 면허 수의 전문가를 위한 임상 참고 자료입니다. 항상 최신 라벨과 개별 환자에 대해 확인하십시오.

투여 경로

IVPO

금기

Infections susceptible to other, lower-tier antibiotics
Intramuscular (IM), Subcutaneous (SC), or Intraperitoneal (IP) administration
Rapid IV bolus administration

이상반응

Nephrotoxicity (especially with concurrent nephrotoxic drugs)
Ototoxicity (hearing loss/vestibular signs)
Thrombophlebitis (if given IV too rapidly)
Severe hypotension or cardiac arrest (rare, associated with rapid IV bolus)
Severe tissue damage and pain (if given IM, SC, or IP)
Nausea and inappetence (with oral administration)
Reversible neutropenia (with high/prolonged dosing)
Hypersensitivity/dermatologic reactions (known in humans as 'Red Man Syndrome' due to histamine release)

약물 상호작용

Aminoglycosides (e.g., gentamicin, amikacin) · Synergistic antibacterial effect, but significantly increases the risk of ototoxicity and nephrotoxicity. Enhanced monitoring is required.
Anesthetic agents · May cause erythema and histamine-like flushing (reported in human pediatric patients).
Nephrotoxic drugs (e.g., amphotericin B, cisplatin) · Increased risk of severe nephrotoxicity; use together with extreme caution.

모니터링

Renal function (BUN, Creatinine, Urinalysis) at baseline and periodically during treatment
Vancomycin serum trough levels (maintain above 5 mcg/mL; some specialists recommend 10-15 mcg/mL)
Periodic Complete Blood Count (CBC) if therapy is prolonged (to monitor for neutropenia)
Hearing and vestibular function (clinical observation)

과용량

Patients with severe colitis taking an oral overdose could potentially absorb enough drug to cause systemic adverse effects. Intravenous overdoses significantly increase the risk of **ototoxicity** (hearing/balance damage) and **nephrotoxicity** (kidney damage). * **Toxicity Data:** The IV LD50 in mice is 400 mg/kg and in rats is 319 mg/kg. * **Treatment:** Treatment is primarily supportive care. Hemodialysis does not appear to remove the drug in significant amounts.

VetSheet 약물 레퍼런스는 면허 수의 전문가를 위한 임상 의사결정 보조 도구이며, 전문적 판단이나 제조사의 최신 라벨을 대신하지 않습니다.