萬古黴素
Vancomycin
Vancomycin hydrochloride
別名: Vancocin · vancomycini
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Confirmed bacteremia/septicemia for enterococci or staphylococci resistant to other commonly used antibiotics | 15 mg/kg IV over 30-60 minutes | IV | q6-8h | — | 🌎 NA |
| Serious infections | 15 mg/kg IV over 30-60 minutes | IV | q6h | — | 🌎 NA |
| C. difficile enterocolitis | 10-20 mg/kg PO | PO | q6h | 5-7 days | 🌎 NA |
| Skin, urinary, soft tissue infections | 10-20 mg/kg IV | IV | q12h | 7-10 days | 🌎 NA |
| Systemic infections, bacteremia | 15 mg/kg IV | IV | q6h | 10 days | 🌎 NA |
- Serious infections: For successful therapy, an aminoglycoside such as gentamicin or amikacin should also be administered.
- C. difficile enterocolitis: Oral vancomycin is not appreciably absorbed and is only effective for susceptible enteric infections.
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Confirmed bacteremia/septicemia for enterococci or staphylococci resistant to other commonly used antibiotics | 15 mg/kg IV over 30-60 minutes | IV | q6-8h | — | 🌎 NA |
| Serious infections | 15 mg/kg IV over 30-60 minutes | IV | q6h | — | 🌎 NA |
- Serious infections: For successful therapy, an aminoglycoside such as gentamicin or amikacin should also be administered.
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
概覽
萬古黴素 (Vancomycin) 是一種強效的殺菌性糖肽類抗生素，在人類和獸醫學中傳統上被視為「最後一線藥物」。
- 臨床作用： 嚴格保留用於治療由多重耐藥革蘭氏陽性菌引起的嚴重、危及生命的感染，例如耐甲氧西林金黃色葡萄球菌 (MRSA)、耐甲氧西林偽中間葡萄球菌 (MRSP) 以及多重耐藥的腸球菌。
- 給藥方式： 對於全身性感染，必須以緩慢靜脈輸注 (IV) 的方式給藥。嚴禁皮下 (SC) 或肌肉 (IM) 注射，因為會導致嚴重的組織壞死和疼痛。
- 口服使用： 由於萬古黴素不會透過胃腸道吸收，口服給藥專門用於治療嚴重的局部腸道感染，特別是由困難梭狀芽孢桿菌 (Clostridium difficile) 引起的偽膜性腸炎。
臨床要點： 由於萬古黴素在治療人類致命感染中具有至關重要的地位，其在獸醫學中的使用極具爭議，只有在細菌培養和藥敏試驗證實沒有其他可行的抗生素選擇時才應考慮使用。
作用機制
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.
安全性與警告
禁忌症
- Infections susceptible to other, lower-tier antibiotics
- Intramuscular (IM), Subcutaneous (SC), or Intraperitoneal (IP) administration
- Rapid IV bolus administration
不良反應
- 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)
注意事項
Must be administered IV over at least 30-60 minutes as a dilute solution to prevent thrombophlebitis and severe hypotension. Dosages must be reduced or dosing intervals increased in patients with renal dysfunction. Therapeutic drug monitoring (trough levels) is highly recommended. Strictly reserve for multi-drug resistant infections to prevent the emergence of Vancomycin-Resistant Enterococci (VRE) or Staphylococci (VRSA).
藥物相互作用
Synergistic antibacterial effect, but significantly increases the risk of ototoxicity and nephrotoxicity. Enhanced monitoring is required.
May cause erythema and histamine-like flushing (reported in human pediatric patients).
Increased risk of severe nephrotoxicity; use together with extreme caution.
監測
- 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)
藥物動力學
半衰期
吸收
Not appreciably absorbed when given orally. Oral administration only achieves local therapeutic concentrations in the GI tract.
分佈
Widely distributed after intravenous administration. Therapeutic levels can be found in pleural, ascitic, pericardial, and synovial fluids. Does not readily distribute into the cerebrospinal fluid (CSF) at usual serum levels.
代謝
Undergoes minimal hepatic metabolism.
排除
Eliminated primarily unchanged via glomerular filtration in the kidneys; small amounts are excreted into the bile. Prolonged dosing or renal impairment can cause significant drug accumulation.
過量
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.
可用產品
劑型
- Oral capsules
- Powder for injection solution
人用標示
- Vancomycin HCl Oral Capsules: 125 mg & 250 mg (Vancocin)
- Vancomycin HCl Powder for Injection Solution: 500 mg, 750 mg, 1 gram, 5 grams, & 10 grams
各地核准狀態
暫無法規資料: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
Store unmixed powder/capsules at room temperature in tight containers, protected from light. Once reconstituted, injectable or oral solutions are stable for 14 days if refrigerated. If further diluted for IV use (with D5W or 0.9% NaCl), solutions are stable for 24 hours at room temperature and 2 months if refrigerated.
飼主須知
萬古黴素是一種高度專業化的抗生素，專門用於治療非常嚴重的感染。
- 住院治療 (靜脈注射)： 如果您的寵物需要透過注射接受此藥物，必須在醫院內進行，因為它必須緩慢地注入靜脈以防止嚴重的副作用。
- 居家護理 (口服)： 如果獸醫讓您帶口服萬古黴素回家，這專門是為了治療嚴重的腸道感染（如困難梭狀芽孢桿菌）。
- 給藥方式： 請嚴格按照獸醫的指示給予口服藥物。即使您的寵物看起來已經好轉，也不要漏服或提早停藥，以防止細菌產生抗藥性。
- 飲食： 如果藥物讓您的寵物腸胃不適，您可以將口服膠囊/藥水與少量食物一起餵食。
- 副作用： 請密切觀察並向獸醫報告任何噁心、食慾不振、嘔吐或排尿習慣改變的跡象。
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