[Critical review of a suboptimal antibiotic, frequently overused and inappropriately dosed: Vancomycin]

Area of Science:

• Pharmacology and Infectious Diseases
• Antimicrobial Stewardship

Background:

• Vancomycin is a primary treatment for Gram-positive cocci like Staphylococcus aureus and Enterococcus spp.
• Its use is widespread for nosocomial infections, but suboptimal pharmacokinetics and narrow therapeutic index present challenges.
• Overutilization stems from overestimated infection rates and the etiological role of resistant cocci.

Purpose of the Study:

• To evaluate the current role and challenges of vancomycin in treating resistant Gram-positive infections.
• To highlight issues of vancomycin overutilization and inappropriate dosing.
• To emphasize the need for understanding vancomycin's strengths, weaknesses, and proper administration.

Main Methods:

• Review of vancomycin's pharmacological properties and pharmacokinetic variability.
• Analysis of current epidemiology and microbiology of relevant infections.
• Assessment of common administration and monitoring errors.

Main Results:

• Vancomycin's efficacy is compromised by higher minimum inhibitory concentrations (MICs) and emerging enterococcal resistance.
• Frequent dosing errors include omitting loading doses, inadequate therapeutic drug monitoring, and failure to adjust for renal function.
• Despite limitations and newer agents, vancomycin retains a role in specific clinical scenarios.

Conclusions:

• Understanding vancomycin's limitations and the epidemiology of infections is crucial.
• Proper administration, therapeutic drug monitoring, and selective indication are essential for preserving its utility.
• Prudent use will maintain vancomycin's value in the evolving landscape of antimicrobial therapy.