West Virginia
Infectious Disease Epidemiology Program

Recommendations for Prudent Vancomycin Use

(From: "Recommendations for Preventing the Spread of Vancomycin Resistance," HICPAC, Centers for Disease Control and Prevention, 1995.)

Situations in Which the Use of Vancomycin is Appropriate or Acceptable:

Treatment of serious infections due to beta-lactam-resistant gram-positive microorganisms.

Treatment of infections due to gram-positive microorganisms in patients with serious allergy to beta-lactam antimicrobials.

Treatment of severe and potentially life-threatening antibiotic-associated colitis (AAC); or treatment of AAC that fails to respond to metronidazole therapy.

Prophylaxis, as recommended by the American Heart Association, for endocarditis following certain procedures in patients at high risk for endocarditis.

Prophylaxis for major surgical procedures involving implantation of prosthetic materials or devices, e.g., cardiac and vascular procedures and total hip replacement, at institutions with a high rate of infections due to methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-resistant Staphylococcus epidermidis (MRSE). A single dose administered immediately before surgery is sufficient unless the procedure lasts more than 6 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 with life-threatening allergy to beta-lactam antibiotics.

Empiric antimicrobial therapy for a febrile neutropenic patient, unless there is strong evidence at the outset that the patient has an infection due to gram-positive microorganisms (e.g., inflamed exit site of Hickman catheter), and the prevalence of infections due to MRSA in the hospital is substantial.

Treatment in response to a single blood culture positive for coagulase-negative staphylococcus, if other blood cultures drawn in the same time frame are negative (i.e., if contamination of blood cultures is likely).

Continued empiric use for presumed infections in patients whose cultures are negative for beta-lactam-resistant gram-positive microorganisms.

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 due to beta-lactam-sensitive gram-positive microorganisms in patients with renal failure.

Use of vancomycin solution for topical application or irrigation.

State of West Virginia (WV)
West Virginia Department of Health and Human Resources (DHHR)
Bureau for Public Health (BPH)
Office of Epidemiology and Health Promotion (OEHP)
Division of Surveillance and Disease Control (DSDC)
Infectious Disease Epidemiology Program (IDEP)

A-Z Listing of West Virginia's Reportable Diseases

This page was last updated June 1997.
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