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Volume 11, Number 10—October 2005


Vancomycin and Home Health Care

Thomas G. Fraser*1, Valentina Stosor*, Qiong Wang†, Anne Allen‡, and Teresa R. Zembower*Comments to Author 
Author affiliations: *Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; †University of Illinois at Chicago School of Public Health, Chicago, Illinois, USA; ‡Northwestern Memorial Hospital, Chicago, Illinois, USA

Main Article

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.

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1Current affiliation: Cleveland Clinic Foundation, Cleveland, Ohio, USA