Fortified Vancomycin (U.S.N.L.M.)
Dosing/ Keratitis	Every 30 minutes for 3 hours, then qhr for first 24 hours, taper gradually on improvement. (If non central consider besifloxacin .)
Chem Specs	vancomycin 5%
Quantities	500mg powder (reconstitute with 10ml sterile water)
Cost	866.38 / 500mg vial
Class	Glycopeptide
Action	Binds to amino acids necessary for bacterial cell wall synthesis and alters bacterial cell membrane permeability.
Activity	Narrow spectrum antibiotic. Bactericidal against certain gram-positive organisms. Not active against gram-negative bacilli, mycobacteria, or fungi.
Usage	Indicated for the treatment of serious or severe infections caused by susceptible strains of methicillin-resistant staphylococci (MRSA) and penicillin-resistant streptococci.
Contraindications	Known hypersensitivity to vancomycin.
Pediatric use	Systemically used in infants > 7 days.
Pregnancy	No adequate and well-controlled studies in pregnant women. Animal reproduction studies have not been conducted with vancomycin.
	The aqueous solution is unstable but may be kept refrigerated for 4 days (96hr). When reconstituted may be labeled as 50 mg/ml vancomycin solution.
Consider concomitant cycloplegia for anterior uveitis. Fortified Vancomycin is used for gram-negative coverage. 5% solution stings on administration. Some advocate 2.5% which is thought to be adequate.¹

1. Romanowski EG, Romanowski JE, Shanks RMQ, et al. Cornea. October 24, 2019.