Volume 11, Number 10—October 2005
Research
Vancomycin and Home Health Care
Thomas G. Fraser*1, Valentina Stosor*, Qiong Wang†, Anne Allen‡, and Teresa R. Zembower*
Table 1
HICPAC guidelines for prudent use of parenteral vancomycin*
| 1) Situations in which use of vancomycin is appropriate |
| A) Treatment of serious infections caused by β-lactam-resistant, gram-positive organisms |
| B) Treatment of infections caused by gram-positive microorganisms in patients with serious allergies to β-lactam antimicrobial agents |
| C) Prophylaxis, as recommended by the American Heart Association, after certain procedures in patients at high risk for endocarditis |
| D) Prophylaxis for major surgical procedures involving implantation of prosthetic materials or devices at institutions that have a high rate of infections caused by MRSA or methicillin-resistant Staphylococcus epidermidis |
| 2) Situations in which use of vancomycin should be discouraged |
| A) Routine surgical prophylaxis, unless patient has life-threatening allergy to β-lactam antimicrobial drugs |
| B) Empiric antimicrobial therapy for febrile neutropenic patient, unless evidence indicates patient has infection caused by gram-positive microorganisms and prevalence of MRSA infections in hospital is substantial |
| C) Treatment in response to single blood culture positive for coagulase-negative staphylococci, if other blood cultures taken during same timeframe are negative |
| D) Continued empiric use for presumed infections in patients whose cultures are negative for β-lactam-resistant gram-positive microorganisms |
| E) Systemic or local (e.g., antimicrobial drug lock therapy)† prophylaxis for infection or colonization of intravascular catheters |
| F) Eradication of MRSA colonization |
| G) Routine prophylaxis for very-low-birthweight infants |
| H) Routine prophylaxis for dialysis patients |
| I) Treatment (chosen for dosing convenience) of infections caused by β-lactam-sensitive, gram-positive microorganisms in patients with renal failure |
*Summarized from reference 7. HICPAC, Hospital Infection Control Practices Advisory Committee; MRSA, methicillin-resistant Staphylococcus aureus.
†Instilling a high concentration of antimicrobial drug to which organism is susceptible into lumen of catheter in attempt to sterilize it.
1Current affiliation: Cleveland Clinic Foundation, Cleveland, Ohio, USA
