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Vancomycin is very irritating to tissue and causes injection site necrosis if injected intramuscularly. Pain and thrombophlebitis occur in many patients receiving vancomycin and are occasionally severe. The frequency and severity of thrombophlebitis can be minimised if the drug is administered as a dilute solution (2.5-5 mg/ml) of Dextrose 5% or Normal Saline 0.9% solution and if the sites of injection are changed regularly.
All patients receiving vancomycin should have periodic haematological studies, urine analysis, liver and renal function tests.
Anaesthetic induced myocardial depression may be enhanced by vancomycin. During anaesthesia, doses must be well diluted and administered slowly with close cardiac monitoring. Position changes should be delayed until the infusion is completed to allow for postural adjustment.
Patients taking oral vancomycin should be warned of its offensive taste.
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