What restrictions should be placed on the use of vancomycin for prevention of VRE?

Updated: Jun 10, 2021
  • Author: Susan L Fraser, MD; Chief Editor: John L Brusch, MD, FACP  more...
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Vancomycin restriction guidelines include the following:

  • Limit use to situations in which vancomycin is clearly indicated.

  • Treat proven or possible serious infection due to susceptible pathogens in patients with serious beta-lactam allergies.

  • Treat proven or possible serious infections caused by beta-lactam–resistant, gram-positive organisms (eg, oxacillin-resistant S aureus [ORSA or MRSA] or methicillin-resistant coagulase-negative staphylococci).

  • Treat Clostridium difficile colitis that is severe or unresponsive to metronidazole therapy.

  • Use for single-dose surgical prophylaxis in patients at high risk for MRSA or methicillin-resistant S epidermidis and occasionally for endocarditis prophylaxis, as recommended by the American Heart Association.

  • Vancomycin-prescribing interventions do not always reduce VRE colonization and infection. [64] Studies have shown that other infection-control measures in addition to vancomycin-prescribing restrictions are more likely to control VRE colonization and infection. [65]

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