HICPAC guidelines on proper use of vancomycin
HICPAC guidelines on proper use of vancomycin
The Centers for Disease Control and Prevention Hospital Infection Control Practices Advisory Committee guidelines for vancomycin use are summarized as follows:1
Situations in which the use of vancomycin is appropriate or acceptable:
* for treatment of serious infections caused by beta-lactam-resistant gram-positive micro-organisms;
* for treatment of infections caused by gram-positive micro-organisms in patients who have serious allergies to beta-lactam antimicrobials;
* when antibiotic-associated colitis fails to respond to metronidazole therapy or is severe and potentially life-threatening;
* prophylaxis for endocarditis following certain procedures in patients at high risk for endocarditis;
* prophylaxis for major surgical procedures involving implantation of prosthetic materials or devices at institutions that have a high rate of infections caused by methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-resistant S. Epidermidis. A single dose of vancomycin administered immediately before surgery is sufficient unless the procedure lasts more than six hours, in which case the dose should be repeated. Prophylaxis should be discontinued after a maximum of two doses.
Situations in which the use of vancomycin should be discouraged:
* routine surgical prophylaxis other than in a patient who has a life-threatening allergy to beta-lactam antibiotics;
* empiric antimicrobial therapy for a febrile neutropenic patient, unless initial evidence indicates that the patient has an infection caused by gram-positive microorganisms (e.g., at an inflamed exit site of Hickman catheter) and the prevalence of infections caused by MRSA in the hospital is substantial;
* treatment in response to a single blood culture positive for coagulase-negative staphylococcus, if other blood cultures taken during the same time frame are negative (i.e., if contamination of the blood culture is likely);
* continued empiric use for presumed infections in patients whose cultures are negative for beta-lactam-resistant gram-positive micro-organisms;
* systemic or local (e.g., antibiotic lock) prophylaxis for infection or colonization of indwelling central or peripheral intravascular catheters;
* selective decontamination of the digestive tract;
* eradication of MRSA colonization;
* primary treatment of antibiotic-associated colitis;
* routine prophylaxis for very low birth weight infants;
* routine prophylaxis for patients on continuous ambulatory peritoneal dialysis or hemodialysis;
* treatment (chosen for dosing convenience) of infections caused by beta-lactam-sensitive gram-positive microorganisms in patients who have renal failure;
* use of vancomycin solution for topical application or irrigation;
Reference
1. Centers for Disease Conrol and Prevention. Recommendations for preventing the spread of vancomycin resistance. Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 1995; 44:(RR-12)1-13. *
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