Instruct Your Physicians About Vancomycin
Advantages:Active against methicillin-resistant Staphylococcus aureus (MRSA) and coagulase-negative staphylococci; most ampicillin-resistant enterococci. Can be used safely in penicillin-allergic patients.
Why vancomycin is restricted:
1. Overuse promotes emergence/persistence of vancomycin-resistant enterococci.
2. Threat of resistance is developing in staphylococci and pneumococci.
3. Cost of vancomycin is $13/day vs. $6 for nafcillin or cefazolin.
4. Vancomycin is inferior to nafcillin for serious (methicillin-sensitive) S. aureus infections.
Settings where vancomycin use might be considered:
1. For infections due to gram-positive organisms where alternative agents — penicillin, nafcillin, or cefazolin — are not suitable or are contraindicated, such as documented resistance to coagulase-negative staph or MRSA.
2. In patients with histories of serious immediate-type penicillin hypersensitivity.
Cautions:
1. Nafcillin is more effective for serious (methicillin-sensitive) S. aureus infections.
2. "Red Man Syndrome" (histamine release reaction) may develop with overly rapid infusion.
3. Vancomycin may have synergistic nephrotoxicity with aminoglycosides or cyclosporin.
Source: University of Minnesota Academic Health Center, Minneapolis.
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