Vancomycin: Preparing a liquid formulation

What is vancomycin?

Vancomycin is an antibiotic. When given by mouth (orally), vancomycin is used to treat or prevent certain types of bacterial infections occurring in the stomach or intestine. Vancomycin is available as capsules, special pharmacy-prepared suspensions and injectable solution.

This guide will help you prepare liquid doses of vancomycin from its injectable form.

You will need:

• vancomycin 500 mg injection bottle
• 10 mL intravenous (IV) syringe
• blunt fill needle (size 18 gauge)
• sterile water for injection bottle (bottle sizes can vary)
• alcohol swab
• oral syringe(s) with cap(s)
• sharps container

Check the expiry dates on the vancomycin and sterile water bottles to ensure they are not expired.

How to prepare vancomycin solution

1. Clean an area where you can prepare the dose.
2. Wash your hands with soap and water.
3. Clean the rubber stopper on the vancomycin bottle and sterile water bottle with an alcohol swab. Wait 30 seconds for the alcohol to dry.
4. Attach the 18-gauge blunt fill needle to the tip of the 10 mL IV syringe and rotate it clockwise to tighten.
5. Remove the cap from the needle.
6. Push the needle through the rubber stopper on the sterile water bottle.
7. Turn the bottle upside down with the syringe in it. Ensure the tip of the needle is in the sterile water.
8. Slowly pull down on the plunger of the syringe and draw up 10 mL of sterile water into the syringe.
9. Turn the bottle right side up and remove the needle and syringe from the sterile water bottle.
10. Push the needle through the rubber stopper on the vancomycin bottle and inject the 10 mL of sterile water into the bottle by pressing down the plunger.
11. Remove the needle and syringe from the vancomycin bottle. Place the syringe on the clean surface you are working on. Be sure not to touch the exposed needle to any surfaces.
12. Slightly shake the vancomycin bottle until the liquid is clear. This will make a 50 mg/mL vancomycin solution.

How to draw up vancomycin doses

1. Using the same needle and syringe, push the needle through the rubber stopper on the vancomycin bottle you prepared from steps 1–12 of the previous section.
2. Turn the vancomycin bottle upside down with the syringe in it. Ensure the tip of the needle is in the solution.
3. Slowly pull down on the plunger of the syringe until you have withdrawn 10 mL vancomycin solution in the syringe (you will separate the 10mL into the prescribed doses in later steps). If you have trouble pulling out the medicine, you will need to push the plunger to inject any medicine you’ve managed to pull up back into the bottle. Then, remove the needle from the vial and draw up some air (up to the 2mL mark on the syringe), and reinsert the needle to inject the air into the bottle and try again.
4. Check the syringe for air bubbles. Tap the syringe to make any air bubbles float to the top. Slowly push up the plunger to exactly 10 mL.

5. Remove the needle from the vancomycin bottle. Be sure not to touch the exposed needle to any surfaces.

   Your child’s dose is ______ mg vancomycin = ______ mL

6. Pull the plunger of an oral syringe down to measure ______ mL.
7. Gently inject ______ mL (the volume of one dose) into the oral syringe.
8. Each bottle will provide ______ doses (up to 4 doses) of vancomycin. Repeat steps 6 and 7 for each dose that a bottle is able to provide.
9. Place a cap on each oral syringe. These syringes should be stored in the refrigerator and must be used within 24 hours.

How to give vancomycin solution to your child

• Prepared vancomycin solution doses in the oral syringe can be administered via your child’s feeding tube. Flush each dose well with at least 10 mL of water.
• If your child needs to take the medicine by mouth, you may dilute the vancomycin dose in 30 mL of water to improve taste.

Storing vancomycin

Store unopened vials of vancomycin injectable solution at room temperature. Once opened, the vancomycin injectable solution should be stored in the refrigerator and used within 24 hours of preparation.

Safe disposal

Discard all syringes and needles in a thick, plastic bottle or sharps container with a lid. Do not put it in your regular garbage. When the container is full, bring it to your local pharmacy. They can safely dispose of it for you.

Vancomycin vials with excess or expired injectable solution should be returned to your local pharmacy for safe disposal.

Fresenius Kabi Canada (2015). Vancomycin Hydrochloride for Injection Product Monograph. Retrieved from https://www.fresenius-kabi.com/en-ca/documents/Vanco-for-Inj.-PM-ENG-v1.0-clean.pdf

The Hospital for Sick Children (2018). Vancomycin IV administration guidelines. Retrieved from http://online.lexi.com/lco/action/doc/retrieve/docid/sickkids_f/5719799

Gheorghe, Alina (2018). Medical Information Department – Fresenius Kabi Canada.

Keep vancomycin out of your child’s sight and reach and locked up in a safe place. If your child takes too much vancomycin, call your local Poison Information Centre at one of these numbers. These calls are free. 

• Call 1-844 POISON-X, or 1-844-764-7669, from anywhere in Canada except Quebec.
• Call 1-800-463-5060 if you live in Quebec.