Situations for which the use of vancomycin is appropriate and acceptable

1. For treatment of serious infections due to β-lactam-resistant grampositive bacteria. Clinicians should be aware that vancomycin is usually less active and less rapidly bactericidal than β-lactam agents for organisms that are susceptible to the β-lactams. Clinicians should also be aware that vancomycin sensitive MIC 2mcg/ml is associated with increased treatment failures.
2. For treatment of infections due to gram-positive organisms in patients with serious allergy to β-lactamantibiotics.
3. Prophylaxis, (infused 60-120 min before the first incision), in penicillinallergic patients, as recommended by the Amer. Heart Assoc., for endocarditis following certain procedures in patients at high risk for endocarditis. Cephalosporins are still recommended for non-allergic patients.
4. Prophylaxis for major surgical procedures involving implantation of prosthetic materials or devices, e.g., cardiac and vascular procedures and total hip replacements, at institutions with a high rate of infections due to MRSA or MRSE. Currently MRSA and MRSE rates are 31% and 73% at SHC, respectively. A single dose administered 60-120 min before surgery is sufficient unless the procedure lasts more than 6 hours, in which case the dose should be repeated. Prophylaxis should be dc’d after 2 doses maximum.