Vancomycin

• Most gram-positive cocci and bacilli, including almost all Staphylococcus aureus and coagulase-negative staphylococcal strains that are resistant to penicillins and cephalosporins

• Many strains of enterococci (mostly Enterococcus faecalis)

However, many strains of enterococci and some strains of S. aureus are resistant.

endocarditis

• Methicillin-resistant S. aureus

• Methicillin-resistant coagulase-negative staphylococci

• Certain beta-lactam–resistant and multidrug-resistant Streptococcus pneumoniae

• Beta-hemolytic streptococci (when beta-lactams cannot be used because of drug allergy or resistance)

• Corynebacterium species including C. jeikeium, and C. striatum

• Viridans streptococci (when beta-lactams cannot be used because of drug allergy or resistance)

• Enterococci (when beta-lactams cannot be used because of drug allergy or resistance)

S. aureusmeningitis

Clostridioides (formerly, Clostridium) difficile–induced diarrheaC. difficileC. difficile2021 clinical practice guidelines on the management of Clostridioides difficile infection in adultsC. difficile infection.

C. difficile–induced diarrhea in pregnant women.

The main concern

• Hypersensitivity (allergic or due to direct mast-cell degranulation)

> 2 weeks.

Other potential adverse effects

Doses used for meningitis must be higher than usual.

Dose reduction is required in renal insufficiency.

In patients with documented or suspected invasive methicillin-resistant S. aureus2020 therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections guidelines revised by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists.)

These dosing recommendations apply only to MRSA and should not be used to guide dosing for other gram-positive infections.

S. aureus

• ≤ 2 mcg/mL (≤ 1.4 micromol/L): Sensitive

• 4 to 8 mcg/mL (2.8 to 5.5 micromol/L): Intermediate

• > 8 mcg/mL (> 5.5 micromol/L): Resistant

However, infections due to S. aureus

The following are English-language resources that may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

1. Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): Focused update guidelines on the management of Clostridioides difficile infection in adults (2021)

2. American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists: Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections guidelines (2020)