Instruct Your Physicians About Vancomycin
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.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.