Summary of Hospital Infection Control Practices Advisory Committee Recommendations Regarding Prudent Vancomycin Use

A. Situations in which the use of vancomycin is appropriate or acceptable:

1. Serious infection with beta-lactam-resistant gram-positive organisms

2. Infections with gram-positive organisms in patients with serious allergy to beta-lactam antimicrobial agents

3. When antibiotic-associated colitis (AAC) fails to respond to metronidazole therapy or if AAC is severe and potentially life-threatening

4. Prophylaxis, as recommended by the American Heart Association, for endocarditis in certain situations

5. Prophylaxis for major surgical procedures involving implantation of prosthetic materials or devices at institutions with high rates of infections due to methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-resistant S. epidermidis (prophylaxis should be discontinued after a maximum of two doses)

B. Situations in which the use of vancomycin should be discouraged:

1. Routine surgical prophylaxis other than in a patient with life-threatening allergy to beta-lactam antimicrobial agents

2. Empiric therapy for a febrile neutropenic patient, unless there is strong evidence that patient has an infection due to gram-positive micro-organisms, and prevalence of infections due to MRSA in the hospital is substantial

3. Treatment in response to a single blood culture for coagulase-negative staphylococcus, if other blood cultures drawn in the same time frame are negative

4. Continued empiric use for presumed infections in patients whose cultures are negative for beta-lactam-resistant gram-positive microorganisms

5. Systemic or local prophylaxis for infection or colonization of indwelling central or peripheral catheters

6. Selective decontamination of the digestive tract

7. Eradication of MRSA colonization

8. Primary treatment of AAC

9. Routine prophylaxis of low birth-weight infants

10. Routine prophylaxis for patients on continuous ambulatory peritoneal dialysis or hemodialysis

11. Treatment of infections due to beta-lactam-sensitive gram-positive micro-organisms in patients with renal failure (for dosing convenience)

12. Use of vancomycin solution for topical application or irrigation

Source: Centers for Disease Control and Prevention, Atlanta.