Principles of vancomycin use in adults

Vancomycin is a glycopeptide antibiotic primarily used for empirical or directed treatment or prophylaxis of methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant coagulase-negative staphylococcal species (eg Staphylococcus epidermidis) or Enterococcus faecium infection. It is inferior to beta-lactam antibiotics for the treatment of methicillin-susceptible S. aureus (MSSA).

Vancomycin has a narrow therapeutic window. It is associated with nephrotoxicity (ie acute kidney injury), ototoxicity, cutaneous reactions, hypersensitivity and haematological toxicity.

Suggested approaches to limiting the risk of acute kidney injury caused by vancomycin therapy includeWatkins 2017:

• optimising vancomycin dosing
  • avoiding a loading dose unless the patient is critically ill
  • monitoring the area under the concentration–time curve over a 24-hour period (AUC₂₄) rather than the trough concentration
• minimising the duration of treatment with vancomycin, as appropriate for the indication and microbiology results
• maintaining adequate hydration
• avoiding concomitant use of nephrotoxins
• using vancomycin as monotherapy when appropriate
• checking kidney function daily to enable dose reduction or cessation of vancomycin in response to decreasing kidney function.

Advice on vancomycin use in adults is included in the following topics:

• Vancomycin administration advice
• Approach to vancomycin dosing and monitoring in adults
• Vancomycin dosing in adults
• Vancomycin monitoring and dosage adjustment in adults
• Vancomycin dosing, monitoring and dosage adjustment in adults undergoing dialysis.