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Vancomycin
1Infectious Disease Division, Winthrop-University Hospital, Mineola, New York, USA.
Abstract:
Vancomycin is a nontoxic glycopeptide antibiotic most often used to treat serious gram-positive infections, C. difficile diarrhea/colitis, and endocarditis and hemodialysis shunt prophylaxis. Vancomycin should not be added to drug regimens for gram-positive coverage, and the empiric use of vancomycin should be discouraged to avoid the emergence of VRE. Vancomycin serum levels are no longer necessary or cost effective in most patients because vancomycin is not nephrotoxic.
Insights
Vancomycin, an antibiotic for serious gram-positive infections, should not be used empirically to prevent VRE. Monitoring vancomycin serum levels is unnecessary as the drug is not nephrotoxic.
Area of Science:
- Pharmacology
- Infectious Diseases
- Nephrology
Background:
- Vancomycin is a critical glycopeptide antibiotic for severe gram-positive infections.
- It is also used for Clostridioides difficile infections and endocarditis prophylaxis.
Purpose of the Study:
- To evaluate the current guidelines and necessity of vancomycin usage.
- To assess the cost-effectiveness and clinical utility of monitoring vancomycin serum levels.
Main Methods:
- Review of current clinical practices and literature regarding vancomycin.
- Analysis of nephrotoxicity data and emergence of vancomycin-resistant enterococci (VRE).
Main Results:
- Vancomycin is generally safe and not nephrotoxic in most patients.
- Empiric use and routine serum level monitoring of vancomycin are not cost-effective and may promote VRE.
Conclusions:
- Vancomycin should be reserved for specific indications and not used empirically.
- Discontinuation of routine vancomycin serum level monitoring is recommended to reduce costs and prevent resistance.