Figure 4
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This is the official hospital's pharmacy and therapeutic committee's restriction document for the antimicrobial, vancomycin.

VANCOMYCIN

Advantages: Active against methicillin-resistant Staphylococcus aureus (MRSA) and coagulase-negative staphylococci; Corynebacterium spp.; Bacillus spp.; most ampicillin-resistant enterococci; C. difficile. Can be used safely in penicillin-allergic patients.

Why restricted:

  1. over-use promotes emergence/persistence of vancomycin-resistant enterococci.
  2. threat of resistance developing in staphylococci and pneumococci.
  3. cost: $13/day, vs. $6 for nafcillin or cefazolin.
  4. inferior to nafcillin for serious (methicillin-sensitive) S. aureus infections.

Settings where use might be considered:

  1. infections due to gram-positive organisms where alternative agents (e.g. penicillin, nafcillin, cefazolin) are not suitable or are contraindicated:
    1. documented resistance to alternative agents, e.g. coagulase-negative staph or MRSA.
    2. patients with history of serious immediate-type penicillin hypersensitivity.

Caution:

  1. nafcillin more effective for serious (methicillin-sensitive) S. aureus infections.
  2. "Red Man Syndrome" (histamine release reaction) with overly-rapid infusion.
  3. may have synergistic nephrotoxicity with aminoglycosides, cyclosporin.