Indications:
1. Culture-documented coagulase-negative staphylococcus infection or culture and sensitivity-documented methicillin-resistant staphylococcus aureus infection.
2. Severe gram-positive infection in patients with chronic renal failure or receiving hemodialysis.
3. Serious enterococcus infections in patients allergic to penicillin.
4. Endocarditis prophylaxis in a patient allergic to penicillin.
5. Suspected gram-positive infection (including staphylococci and streptococci) in patients who are allergic to penicillin.
6. Empiric therapy in conditions in which methicillin resistant S. Aureus or S. Epidermidis is a suspected infectious agent.
7. Antibiotic-associated enterocolitis by oral route only in cases of treatment failure or prohibitive side effects with metronidazole.
Process Indicators:
1. Appropriate cultures obtained within 48 hours before initial vancomycin dose.
2. Pretreatment serum creatinine (Scr) concentrations or creatinine clearance (CLcr) obtained within 48 hours before initial vancomycin therapy.
Dosing:
1. Adults: 10 mg/kg every 8 hours or 15 mg/kg every 12 hours by IV infusion rounded to the nearest convenient dose.
2. Anuric patients: 1 gm every 7-10 days IV-guided by trough level at day 4. (Adjustment of dosage (decrease) in renal impairment)
3. Antibiotic-associated colitis: 125-500 mg every 6 hr PO
Pharmacokinetics consult recommended in patients with abnormal renal function, excessive volume of distribution, critically ill, or unacceptable peak or trough levels.
Monitoring Parameters:
1. Leukocyte count with differential monitored at least once weekly.
2. SCr concentration monitored at least twice weekly if baseline value within normal range
3. Serum vancomycin concentration determined within 72 hours of initial dose in patients with normal renal function or within 1 week of initial dose in patients with calculated vancomycin half-life of >24 hours in the following circumstances:
A. Patients undergoing hemodialysis when at least one of the following is present: endocarditis, graft infection unresolved within 3 weeks, or administration of last vancomycin dose uncertain.
B. Patients with renal impairment OR
C. Patients requiring extended therapy (eg., endocarditis) OR
D. Patients with suspected unusual pharmacokinetic values (eg., large volume of distribution) OR
E. Patients with life-threatening infections (eg., sepsis)
Vancomycin should be infused for one hour and peak serum levels drawn one hour after the infusion is stopped. Peak serum concentrations range from 20-40 ug/ml and trough concentrations range from 5-10 ug/ml.
Outcome Measures:
1. Defervescence within 72 hours
2. Bacteriologic eradications as evidenced by negative cultures within 24 hours after discontinuation of vancomycin.
3. Leukocyte count within normal range.
