Vancomycin and gentamicin (see Gentamicin, [[Gentamicin]]) demonstrate synergism against most Enterococcus species
Methicillin-Resistant Staphylococcus Aureus (MRSA) (see Staphylococcus Aureus, [[Staphylococcus Aureus]])
Synergism: vancomycin and gentamicin (see Gentamicin, [[Gentamicin]]) demonstrate synergism against most Staphylococcus species
Vancomycin is the first line agent: its use has paralleled the increasing emergence of MRSA
Vancomycin does not inhibit production of PVL cytotoxin and may result in some clinical failures
Continuous Vancomycin infusion is not associated with an improved outcome in the treatment of MRSA infection
Methicillin-Sensitive Staphylococcus Aureus (MSSA) (see Staphylococcus Aureus, [[Staphylococcus Aureus]])
Synergism: vancomycin and gentamicin (see Gentamicin, [[Gentamicin]]) demonstrate synergism against most Staphylococcus species
Streptococcus Pneumoniae (Pneumococcus) (see Streptococcus Pneumoniae, [[Streptococcus Pneumoniae]])
Effective against penicillin-resistant Streptococcus Pneumoniae
Contraindications
Hypersensitivity Reaction to Glycopeptides: excluding red man syndrome
Problem with Dosing Frequency in Adjustment for Creatinine Clearance
Strains with Higher MIC to Vancomycin: MIC >2 mg/L
Situations Where IV Administration is Difficult or Undesirable
Situations Where Vancomycin Infusion Would Result in an Unnecessary Prolongation of Hospital Stay
Situations Where Vancomycin Infusion Would Be Complicated By Problematic IV Access
Pharmacology
Glycopeptide Antibiotic Which Inhibits Cell Wall Synthesis in Gram-Positive Bacteria
Inhibits the Bacterial Cell Wall Polymer at a Site of Peptidoglycan Synthesis Earlier Than β-Lactam Antibiotics (see β-Lactam Antibiotics, [[β-Lactam Antibiotics]])
Inhibition of Bacterial RNA Synthesis and Permeability of Cytoplasmic Membranes
Bactericidal Against Almost All Gram-Positive Bacteria, Except Enterococcus
Does Not Cross the Outer Cell Wall of Gram-Negative Organisms: ineffective for these organisms
Tissue Penetration
Central Nervous System/Cerebrospinal Fluid: poor, except when meninges are inflammed
Lung Penetration: poor
Pharmacokinectics
High Concentrations of Heparin (see Heparin, [[Heparin]]): may inactivate vancomycin, leading to antibiotic failure
Administration
IV (For All Indications, Except Clostridium Difficile Colitis): xxx
Desired Trough Level: 15 mg/L
PO (For Clostridium Difficile Colitis): xxx
Adverse Effects
Dermatologic Adverse Effects
Red Man Syndrome
Mechanism: rapid administration of vancomycin with histamine release
Onset: may occur during or immediately after vancomycin infusion
