The Role of Vancomycin in the Treatment Paradigm

• Published in: Clinical infectious diseases Vol. 42; no. Supplement-1; pp. S51 - S57
• Main Author: Stevens, Dennis L
• Format: Journal Article
• Language: English
• Published: United States The University of Chicago Press 01.01.2006; University of Chicago Press; Oxford University Press
• Subjects: Anti-Bacterial Agents - blood; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibacterials; Antibiotics; Bacteremia; Bacteremia - complications; Bacteremia - drug therapy; Bacteremia - microbiology; Bacteriology; Clinical outcomes; Dosage; Drug Therapy, Combination; Effectiveness; Endocarditis; Endocarditis, Bacterial - complications; Endocarditis, Bacterial - drug therapy; Endocarditis, Bacterial - microbiology; Gram-positive bacteria; Humans; Infections; Microbial Sensitivity Tests; Patients; Pneumonia, Staphylococcal - drug therapy; Soft Tissue Infections - drug therapy; Soft Tissue Infections - microbiology; Staphylococcal Infections - complications; Staphylococcal Infections - drug therapy; Staphylococcal pneumonia; Staphylococcal Skin Infections - drug therapy; Staphylococcal Skin Infections - microbiology; Staphylococcus; Staphylococcus aureus; Staphylococcus aureus - drug effects; Treatment Failure; Vancomycin - blood; Vancomycin - pharmacology; Vancomycin - therapeutic use; Ventilator associated pneumonia
• DOI: 10.1086/491714
• ISSN: 1058-4838

Vancomycin was introduced in the United States in 1956 as a possible treatment for infections due to penicillin-resistant Staphylococcus aureus, but it was not used widely because of toxicity and the nearly simultaneous development of semisynthetic antibiotics and cephalosporins. Thus, its main indication was the treatment of serious gram-positive infections in penicillin-allergic patients. For susceptible strains of S. aureus, vancomycin was more rapidly bactericidal than penicillin, nafcillin, or cefazolin, and, in a rabbit model of S. aureus endocarditis, sterilization of vegetations was more rapid with vancomycin. In clinical practice, however, nafcillin remained the treatment of choice for staphylococcal bacteremia, largely because it had failure rates of only 4%. With the appearance of methicillin-resistant S. aureus and coagulase-negative staphylococci, vancomycin became the drug of choice for these infections. Recently, the efficacy of vancomycin has been questioned because of vancomycin's increasing minimum inhibitory concentrations among staphylococci, poor tissue penetration, and apparently slower bacterial killing than previously was recognized.