Instruct Your Physicians About Vancomycin

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.