Vancomycin

J01X - Other antibacterials ATC J01XA01 Small molecule approved 1964 Oral Parenteral Natural product Narrow therapeutic index Black-box warning

JFDA label: VANCOCIN CP Vial

⚠ Black-Box Warning

Mechanism of Action

Inhibitor of Peptidoglycan — Peptidoglycan inhibitor

Target	Action	Gene / class
Peptidoglycan efficacy	INHIBITOR

Indications

Approved

Clostridium difficile infection (oral)
Corynebacteria (diphtheroids)
Endocarditis (injection)
Enterococcal
Enterocolitis (oral)
Staphylococcal
Staphylococcal infections (injection)
Streptococcal

Off-label

Catheter-related infections
Cerebrospinal fluid (CSF) shunt infection
Clostridium difficile infection (adults
Community-acquired pneumonia (children)
Endophthalmitis, treatment
Group B Streptococcus, maternal use (neonatal prophylaxis)
Intra-abdominal infections
Meningitis, bacterial
Perioperative prophylaxis
Peritonitis, treatment (continuous ambulatory peritoneal dialysis [CAPD] patients)
Prosthetic joint infection
Surgical-site infections
rectal administration)

Antimicrobial Spectrum

Expected / intrinsic spectrum (EUCAST breakpoints & labels) — not local resistance. Source: EUCAST v16 · curated · openfda-label.

Bacteria

Organism	Activity	MIC
Anaerobes	Susceptible	2.0 mg/L
Bacillus spp.	Susceptible	2.0 mg/L
Clostridium difficile	Susceptible	2.0 mg/L
Coagulase-negative staphylococci	Susceptible	4.0 mg/L
Corynebacterium spp.	Susceptible	2.0 mg/L
Enterococcus faecalis	Susceptible	4.0 mg/L
Enterococcus faecium	Susceptible	4.0 mg/L
Enterococcus spp.	Susceptible	4.0 mg/L
Listeria monocytogenes	Active	—
Staphylococcus aureus	Susceptible	2.0 mg/L
Staphylococcus epidermidis	Active	—
Streptococcus A/B/C/G	Susceptible	2.0 mg/L
Streptococcus agalactiae	Active	—
Streptococcus bovis	Active	—
Streptococcus gallolyticus	Active	—
Streptococcus pneumoniae	Susceptible	2.0 mg/L
Streptococcus pneumoniae	Susceptible	2.0 mg/L
Streptococcus pyogenes	Active	—
Viridans group streptococci	Susceptible	2.0 mg/L
Enterococcus faecalis	Resistant	4.0 mg/L
Enterococcus faecium	Resistant	4.0 mg/L
Staphylococcus aureus	Resistant	2.0 mg/L

Class profile

gramStatus	Gram+
spectrumBreadth	Narrow
atypicalCoverage	No
isBactericidal	1
moaCategory	Cell wall synthesis inhibitor (glycopeptide, D-Ala-D-Ala binding)
pdIndex	Time-dependent
postAntibioticEffect	Short
mrsaCoverage	1
resistanceMechanisms	VanA/VanB gene clusters (D-Ala-D-Lac substitution),Cell wall thickening (VISA/hVISA),Biofilm formation

Contraindications

Source: Lexicomp

Hypersensitivity to vancomycin or any component of the formulation Absolute

Adverse Reactions

Very Common >10%Common 1–10%Uncommon 0.1–1% Rare 0.01–0.1%Very Rare <0.01%Not Known

Cardiac disorders (2)

Common Local phlebitis · Peripheral edema

Vascular disorders (1)

Common Thrombophlebitis

Nervous system disorders (4)

Common Chills · drug fever · Fatigue · headache

Renal and urinary disorders (2)

Common Nephrotoxicity (elevated serum creatinine) · Urinary tract infection

Blood and lymphatic system disorders (2)

Common Eosinophilia · neutropenia (reversible)

Immune system disorders (1)

Uncommon Hypersensitivity / rash

Gastrointestinal disorders (3)

Common Diarrhea · flatulence · vomiting

Skin and subcutaneous tissue disorders (2)

Very Common Red Man Syndrome (infusion-related flushing)

Common Skin rash

Musculoskeletal and connective tissue disorders (1)

Common Back pain

Ear and labyrinth disorders (1)

Uncommon Ototoxicity (high-level or prolonged therapy)

General disorders and administration site conditions (1)

Common Fever

Other (5)

Very Common Cardiovascular: Hypotension (accompanied by flushing) · dysgeusia (with oral solution) · Gastrointestinal: Abdominal pain · nausea

Not Known Hypersensitivity: Flushing of face and neck (Red man syndrome; may be infusion related)

Dosing

Source: Lexicomp

Usual dosage range: Note: Initial IV dosing in nonobese patients should be based on actual body weight; subsequent dosing should generally be adjusted based on serum trough vancomycin concentrations and renal function. Patient-specific pharmacokinetic calculations may be needed to determine appropriate dose and interval in patients expected to have altered pharmacokinetics (eg, morbid obesity, burns, critical illness, unstable renal function, pregnancy, cystic fibrosis). For patients with uncomplicated skin and soft tissue infections who are not obese and have normal renal function, serum trough monitoring is generally not needed (IDSA [Liu 2011]). IV: Note: Ineffective for treating C. difficile infections (CDIs): 15 to 20 mg/kg/dose (rounded to the nearest 250 mg; usual maximum: 2 g/dose initially) every 8 to 12 hours (ASHP/IDSA/SIDP [Rybak 2009]). Note: 15 mg/kg/dose (usual maximum: 2 g/dose initially) every 12 hours is a usual starting dose in most nonobese patients with normal renal function; refer to infection-specific dosing (Drew 2017; IDSA [Liu 2011]; Murray 2015). Loading dose: Complicated infections in seriously ill patients: A loading dose of 25 to 30 mg/kg (based on actual body weight) may be used to rapidly achieve target concentrations (ASHP/IDSA/SIDP [Rybak 2009]; Reardon 2015). Oral: Note: Ineffective for treating systemic infections: 125 to 500 mg 4 times daily Indication-specific dosing: Bacteremia ( off-label dose): Empiric therapy or pathogen-specific therapy for methicillin-resistant S. aureus: IV: 15 to 20 mg/kg/dose (usual maximum: 2 g/dose initially) every 8 to 12 hours; adjust dose to obtain a trough concentration of 15 to 20 mcg/mL. A loading dose may be considered in seriously ill patients (ASHP/IDSA/SIDP [Rybak 2009]; IDSA [Liu 2011]). For catheter-related bloodstream infections, consider antibiotic lock therapy for catheter salvage, in addition to systemic therapy (IDSA [Mermel 2009]). Empiric therapy or pathogen-specific therapy for methicillin-resistant coagulase-negative staphylococci: IV: 15 to 20 mg/kg/dose (usual maximum: 2 g/dose initially) every 8 to 12 hours (most patients with normal renal function can be started with 15 mg/kg/dose every 12 hours); adjust dose to obtain a trough concentration of 15 to 20 mcg/mL (Drew 2017). For catheter-related bloodstream infections, consider antibiotic lock therapy for catheter salvage, in addition to systemic therapy (IDSA [Mermel 2009]). Antibiotic lock technique (catheter salvage strategy (off-label use): Prepare lock solution to final concentration of vancomycin 5 mg/mL (may be combined with heparin 5,000 units/mL). Instill into each lumen of the catheter access port using a volume sufficient to fill the catheter (2 to 5 mL) with a dwell time of 48 to 72 hours. Dwell times will depend on frequency of catheter use. Withdraw lock solution prior to catheter use; replace with fresh vancomycin lock solution after catheter use. For catheter-related bloodstream infections con

(For additional information see "Vancomycin: Pediatric drug information") Usual dosage range: Note: Initial IV dosing should be based on actual body weight; subsequent dosing adjusted based on serum trough vancomycin concentrations. Infants >2 months (60 days), Children, and Adolescents (Red Book [AAP 2015]): Note: Every 6 hour dosing recommended as initial dosage regimen if targeting trough serum concentrations >10 mcg/mL (Benner 2009; Frymoyer 2009) in patients with normal renal function. Close monitoring of serum concentrations and assurance of adequate hydration status is recommended; utilize local antibiogram and protocols for further guidance. Mild to moderate infection: IV: 40 to 45 mg/kg/day divided every 6 to 8 hours; dose and frequency should be individualized based on serum concentrations; usual maximum daily dose: 2,000 mg/day Severe infection: IV: 45 to 60 mg/kg/day divided every 6 to 8 hours; dose and frequency should be individualized based on serum concentrations; usual maximum daily dose: 4,000 mg/day Indication-specific dosing: Bacteremia ( off-label use): Empiric therapy or pathogen-specific therapy (eg, methicillin-resistant S. aureus): Children and Adolescents: IV: 15 mg/kg/dose every 6 hours for 2 to 6 weeks depending on severity (IDSA [Liu 2011]) Brain abscess, intracranial epidural abscess, spinal epidural abscess ( S. aureus [methicillin-resistant]) (off-label use): As a component of empiric therapy or pathogen specific therapy for methicillin-resistant S. aureus: Children and Adolescents: IV: 15 mg/kg/dose every 6 hours for 4 to 6 weeks (with or without rifampin) (IDSA [Liu 2011]) C. difficile infection (CDI): Infants >1 month, Children, and Adolescents: Manufacturer’s labeling: Oral: 40 mg/kg/day in 3 to 4 divided doses for 7 to 10 days (maximum: 2,000 mg/day) HIV-exposed/-positive patients: Adolescents: Oral: 125 mg 4 times daily for 10 to 14 days (HHS [OI adult 2017]) Endocarditis, treatment (off-label dose): Empiric therapy/culture negative: Children and Adolescents: IV 60 mg/kg/day divided every 6 hours; maximum daily dose: 2,000 mg/day; use in combination with other antibiotics for at least 4 weeks; longer duration may be required if prosthetic material is present; dosage should be adjusted to target trough serum concentrations of 10 to 15 mcg/mL; higher trough concentrations (15 to 20 mcg/mL) may be needed if there is a lack of response or if a resistant organism (MIC >1 mcg/mL) is identified (AHA [Baltimore 2015]) Streptococcus (including enterococcus): Children and Adolescents: IV: 40 mg/kg/day divided every 8 to 12 hours for at least 4 to 6 weeks; a longer duration and additional antibiotics may be required depending on organism and presence of prosthetic material; dosage should be adjusted to target trough serum concentrations of 10 to 15 mcg/mL; higher trough concentrations (15 to 20 mcg/mL) may be needed for resistant organisms (MIC >1 mcg/mL) or if there is a lack of response (AHA [Baltimore 2015]) S. aureu

Refer to adult dosing.

Oral: There are no dosage adjustments provided in the manufacturer’s labeling. However, dosage adjustment unlikely due to low systemic absorption. IV: Note: Vancomycin levels should be monitored in patients with any renal impairment: In critically ill patients with renal insufficiency, the initial loading dose (~25 mg/kg) should not be reduced. However, subsequent dosage adjustments should be made based on renal function and trough serum concentrations (Wang 2001). Vancomycin Initial Dosage Regimens for Patients With Impaired Renal Function (Golightly 2013) eGFR (mL/minute per 1.73 m2) Actual Body Weight 60 to 80 kg 81 to 100 kg >100 kg aCheck a random vancomycin level in 24 hours after the dose. If random level is ≤20 mcg/mL, repeat the dose. If random level is >20 mcg/mL, do not re-dose; repeat random level in 12 hours. >90 750 mg every 8 hours 1,000 mg every 8 hours 1,250 mg every 8 hours 1,500 mg every 8 hours 50 to 90 750 mg every 12 hours 1,000 mg every 12 hours 1,250 mg every 12 hours 1,000 mg every 8 hours 15 to 49 750 mg every 24 hours 1,000 mg every 24 hours 1,250 mg every 24 hours 1,500 mg every 24 hours a 750 mg 1,000 mg 1,250 mg 1,500 mg Dialysis: Poorly dialyzable by intermittent hemodialysis; however, use of high-flux membranes and continuous renal replacement therapy (CRRT) increases vancomycin clearance, and generally requires replacement dosing (Launay-Vacher 2002). End stage renal disease (ESRD) on intermittent hemodialysis (IHD) (administer after hemodialysis on dialysis days): Following loading dose of 15 to 25 mg/kg, give either 500 to 1,000 mg or 5 to 10 mg/kg after each dialysis session (Heintz 2009). Note: Dosing dependent on the assumption of 3 times/week, complete IHD sessions. Redosing based on pre-HD concentrations: 10 to 25 mg/L: Administer 500 to 750 mg after HD >25 mg/L: Hold vancomycin Redosing based on post-HD concentrations: Peritoneal dialysis (PD): 1 g every 4 to 7 days (Aronoff 2007) Continuous renal replacement therapy (CRRT) (Heintz 2009; Trotman 2005): Drug clearance is highly dependent on the method of renal replacement, filter type, and flow rate. Appropriate dosing requires close monitoring of pharmacologic response, signs of adverse reactions due to drug accumulation, as well as drug concentrations in relation to target trough (if appropriate). The following are general recommendations only (based on dialysate flow/ultrafiltration rates of 1 to 2 L/hour and minimal residual renal function) and should not supersede clinical judgment: CVVH: Loading dose of 15 to 25 mg/kg, followed by either 1,000 mg every 48 hours or 10 to 15 mg/kg every 24 to 48 hours CVVHD: Loading dose of 15 to 25 mg/kg, followed by either 1,000 mg every 24 hours or 10 to 15 mg/kg every 24 hours CVVHDF: Loading dose of 15 to 25 mg/kg, followed by either 1,000 mg every 24 hours or 7.5 to 10 mg/kg every 12 hours Note: Consider redosing patients receiving CRRT for vancomycin concentrations

Oral: There are no dosage adjustments provided in the manufacturer’s labeling. However, dosage adjustment unlikely due to low systemic absorption. IV: There are no dosage adjustments provided in the manufacturer’s labeling. However, degrees of hepatic dysfunction do not affect the pharmacokinetics of vancomycin (Marti, 1996).

Warnings & Precautions

Source: Lexicomp

Extravasation and thrombophlebitis

IV vancomycin is an irritant; ensure proper needle or catheter placement prior to and during infusion; avoid extravasation. Pain, tenderness, and necrosis may occur with extravasation. If thrombophlebitis occurs, slow infusion rates, dilute solution (eg, 2.5 to 5 g/L) and rotate infusion sites.

Nephrotoxicity

May cause nephrotoxicity although limited data suggest direct causal relationship; usual risk factors include preexisting renal impairment, concomitant nephrotoxic medications, advanced age, and dehydration. If multiple sequential (≥2) serum creatinine concentrations demonstrate an increase of 0.5 mg/dL or ≥50% increase from baseline (whichever is greater) in the absence of an alternative explanation, the patient should be identified as having vancomycin-induced nephrotoxicity (ASHP/IDSA/SIDP [Rybak 2009]). Discontinue treatment if signs of nephrotoxicity occur; renal damage is usually reversible. Nephrotoxicity has been reported following treatment with oral vancomycin (typically in patients >65 years of age).

Neutropenia

Prolonged therapy and use of concomitant drugs that cause neutropenia may increase the risk; monitor leukocyte counts periodically in these patients. Prompt reversal of neutropenia is expected after discontinuation of therapy.

Ototoxicity

Ototoxicity is rarely associated with monotherapy. It has been most frequently reported in patients receiving excessive doses, those who have underlying hearing loss, or those receiving concomitant ototoxic drugs (eg, aminoglycosides). Serial auditory function testing may be helpful to minimize risk. Ototoxicity may be transient or permanent; discontinue treatment if signs of ototoxicity occur.

Superinfection

Prolonged use may result in fungal or bacterial superinfection, including C. difficile infection (CDI); CDI has been observed >2 months postantibiotic treatment. Disease-related concerns:

Inflammatory bowel disease

Clinically significant serum concentrations have been reported in patients with inflammatory disorders of the intestinal mucosa who have taken oral vancomycin (multiple doses) for the treatment of C. difficile-associated diarrhea. Although use may be warranted, the risk for adverse reactions may be higher in this situation; consider monitoring serum trough concentrations, especially with renal insufficiency, severe colitis, concurrent rectal vancomycin administration, and/or concomitant IV aminoglycosides. The Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) suggest that it is appropriate to obtain trough concentrations when a patient is receiving long courses of ≥2 g/day in adults (SHEA/IDSA [Cohen 2010]).

Renal impairment

Use with caution in patients with renal impairment or those receiving other nephrotoxic or ototoxic drugs; dosage modification required (especially in elderly patients). Accumulation may occur after multiple oral doses of vancomycin in patients with renal impairment; consider monitoring trough concentrations in this circumstance. Concurrent drug therapy issues:

Drug-drug interactions

Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information. Other warnings/precautions:

Appropriate use

Oral vancomycin is only indicated for the treatment of CDI or enterocolitis due to S. aureus and is not effective for systemic infections; parenteral vancomycin is not effective for the treatment of enterocolitis.

Infusion reactions

Rapid IV administration (eg, over • Intraocular administration (off-label route): Hemorrhagic occlusive retinal vasculitis (HORV), including permanent visual loss, has been reported in patients receiving intracameral or intravitreal administration of vancomycin during or after cataract surgery. Safety and efficacy of intraocularly administered vancomycin has not been established; vancomycin is not indicated for prophylaxis of endophthalmitis.

Intraperitoneal administration (off-label route)

Use caution when administering intraperitoneally (IP); in some continuous ambulatory peritoneal dialysis (CAPD) patients, chemical peritonitis (cloudy dialysate, fever, severe abdominal pain) has occurred. Symptoms are self-limited and usually clear after vancomycin discontinuation.

Pregnancy & Lactation

Pregnancy

FDA category C

Caution

Use only for documented/suspected MRSA. AUC-guided dosing with careful renal monitoring

Lactation

RID 4.8%

Vancomycin is present in breast milk following IV administration. Vancomycin exhibits minimal oral absorption; therefore, the amount available to pass into the milk would be limited following oral administration and any amount present in breast milk is unlikely to reach the bloodstream of a breastfed infant. The relative infant dose (RID) of vancomycin is 4.8% when calculated using the highest breast milk concentration located and compared to an infant therapeutic oral dose of 40 mg/kg/day.

Monitoring

Efficacy	AUC₀₋₂₄/MIC-guided dosing (target AUC 400–600 mg·h/L for MRSA); or trough-guided (15–20 mg/L for serious infections); renal function
Toxicity	Nephrotoxicity (rising SCr — particularly with concomitant aminoglycosides, NSAIDs, or amphotericin); ototoxicity (audiogram if prolonged or high-level therapy); Red Man Syndrome (infusion-rate related)
Clinical pearl	AUC-guided monitoring is now preferred over trough-only as it achieves pharmacodynamic targets while minimising nephrotoxicity. Infuse over at least 60 min (120 min for > 2 g doses).
Counseling	Report ringing in the ears, hearing changes, decreased urination, or flushing/rash during infusion. Stay well hydrated.

Chemistry & Properties

Formula	C66H75Cl2N9O24
Molecular weight	1449.27 g/mol
IUPAC name	(1S,2R,18R,19R,22S,25R,28R,40S)-48-[(2S,3R,4S,5S,6R)-3-[(2S,4S,5S,6S)-4-amino-5-hydroxy-4,6-dimethyloxan-2-yl]oxy-4,5-dihydroxy-6-(hydroxymethyl)oxan-2-yl]oxy-22-(2-amino-2-oxoethyl)-5,15-dichloro-2,18,32,35,37-pentahydroxy-19-[[(2R)-4-methyl-2-(methylamino)pentanoyl]amino]-20,23,26,42,44-pentaoxo-7,13-dioxa-21,24,27,41,43-pentazaoctacyclo[26.14.2.23,6.214,17.18,12.129,33.010,25.034,39]pentaconta-3,5,8(48),9,11,14,16,29(45),30,32,34(39),35,37,46,49-pentadecaene-40-carboxylic acid
CAS	1404-90-6
PubChem CID	14969
InChIKey	`MYPYJXKWCTUITO-LYRMYLQWSA-N`

SMILES

CN[C@H](CC(C)C)C(=O)N[C@H]1C(=O)N[C@@H](CC(N)=O)C(=O)N[C@H]2C(=O)N[C@H]3C(=O)N[C@H](C(=O)N[C@H](C(=O)O)c4cc(O)cc(O)c4-c4cc3ccc4O)[C@H](O)c3ccc(c(Cl)c3)Oc3cc2cc(c3O[C@@H]2O[C@H](CO)[C@@H](O)[C@H](O)[C@H]2O[C@H]2C[C@](C)(N)[C@H](O)[C@H](C)O2)Oc2ccc(cc2Cl)[C@H]1O

Biology & Pharmacokinetics

Pharmacokinetics

BBB penetrant	No

Enzyme interactions

Enzyme	Role	Detail
CYP2C19	Substrate	—

Transporters

BCRP (Inhibitor)BSEP (Inhibitor)MRP1 (Inhibitor)OATP1B1 (Inhibitor)OATP1B1 (Inhibitor)OATP1B3 (Inhibitor)OATP1B3 (Inhibitor)OCT1 (Inhibitor)OCTN2 (Inhibitor)P-gp (Inhibitor)P-gp (Substrate)

Drug–drug interactions (100+, DDInter)

Interacting drug	Severity	Management
Cidofovir	major
Deferasirox	major
Diatrizoate	major
Everolimus	major
Human Rho(D) immune globulin	major
Human botulinum neurotoxin A/B immune globulin	major
Human cytomegalovirus immune globulin	major
Human immunoglobulin G (intravenous and subcutaneous)	major
Human immunoglobulin G (intravenous)	major
Inotersen	major
Iodipamide	major
Iodixanol	major
Iohexol	major
Iopamidol	major
Iopromide	major
Iothalamic acid	major
Ioversol	major
Ioxilan	major
Piperacillin	major
Sirolimus	major
Tacrolimus	major
Temsirolimus	major
Typhoid vaccine (live)	major
Vibrio cholerae CVD 103-HgR strain live antigen (live)	major
Amikacin	moderate
Amikacin (liposome)	moderate
Amphotericin B	moderate
Amphotericin B (cholesteryl sulfate)	moderate
Amphotericin B (lipid complex)	moderate
Amphotericin B (liposomal)	moderate
Atracurium	moderate
Bacitracin	moderate
Balsalazide	moderate
Bifidobacterium longum infantis	moderate
Bromfenac	moderate
Capreomycin	moderate
Carboplatin	moderate
Celecoxib	moderate
Cholestyramine	moderate
Cisatracurium	moderate

Showing 40 of 100+.

Registered Products (23)

Brand	Form / strength	Pack	Agent	Citizen (JOD)
Colat 500mg Powder for solution for IV Infusion	Infusion Vancomycin Hcl 512.56 mg	500 mg	Sukhtian Group	—
Polivan 500mg Lyophilised Powder for Solution for I.V Infusion and Oral use	Infusion Vancomycin Hcl 525 mg	(one VIL)	JAWEDA INT. DRUD STORE	—
VANCOCIN CP Vial	Vial 500 mg	10 ml	THE ARAB DRUG STORE P.S.C	—
VANCOSALA 1000 mg, powder for solution for injection.	Powder for Injection 1000 mg	10 vial	Reda Jardaneh Drug Store	—
VANCOSALA 500 mg, powder for solution for injection.	Powder for Injection 500 mg	10 vial	Reda Jardaneh Drug Store	—
VOXIN, Powder for Solution for Infusion 1g/vial	Infusion 1 g	1 vial	Manar Drug Store	—
Vanco	Vial (equivalent to vancomycin 500) mg	1 vial	Hikma Pharmaceuticals Co.Ltd/Jordan	—
Vanco	Vial (equivalant to vancomycin1000) mg	1 vial	Hikma Pharmaceuticals Co.Ltd/Jordan	—
Vancolab	Vial 500 mg	10 vial	ORIENT DRUG STORE CO	—
Vancolab 1 gm	Vial 1000 mg	10 vial	ORIENT DRUG STORE CO	—
Vancolon	Vial 1 g	1 vial	Professional Drug Store	—
Vancolon	Vial 0.5 g	1 vial pack varies	Professional Drug Store	—
Vancolon	Vial 0.5 g	10 vial pack varies	Professional Drug Store	—
Vancomicina Azevedos	Vial 500 mg	10 vial	Alshefra Dru Store company	—
Vancomicina Azevedos	Vial 1000 mg	10 vial	Alshefra Dru Store company	—
Vinkamine 1g/vial powder for solution for injection	Powder for Injection Vancomycin Hcl 1025.1 mg	1 vial	MS Pharma Jordan	—
Voxin	Vial 500 mg	one vial	Manar Drug Store	—
Zermacin	Vial equivalent to 0.5 g Vancomycin	1 vial pack varies	Adonis Drug Store	—
Zermacin	Vial 1 g	1 vial pack varies	Adonis Drug Store	—
Zermacin	Vial 1 g	10 vial pack varies	Adonis Drug Store	—
Zermacin	Vial equivalent to 0.5 g Vancomycin	10 vial pack varies	Adonis Drug Store	—
vinkamine	Vial 500 mg	1 vial pack varies	MS PHARMA/JORDAN	—
vinkamine	Vial 500 mg	10 vial pack varies	MS PHARMA/JORDAN	—