VANCOMYCIN SUMMARY
Sterile Vancomycin Hydrochloride, USP, intravenous, is a chromatographically purified tricyclic glycopeptide antibiotic derived from Amycolatopsis orientalis (formerly Nocardia orientalis) and has the molecular formula C66H75Cl2N9O24• HCl.
Vancomycin hydrochloride is indicated for the treatment of serious or severe infections caused by susceptible strains of methicillin-resistant (β -lactam-resistant) staphylococci. It is indicated for penicillin-allergic patients, for patients who cannot receive or who have failed to respond to other drugs, including the penicillins or cephalosporins, and for infections caused by vancomycin-susceptible organisms that are resistant to other antimicrobial drugs. Vancomycin hydrochloride is indicated for initial therapy when methicillin-resistant staphylococci are suspected, but after susceptibility data are available, therapy should be adjusted accordingly.
Vancomycin hydrochloride is effective in the treatment of staphylococcal endocarditis. Its effectiveness has been documented in other infections due to staphylococci, including septicemia, bone infections, lower respiratory tract infections, skin and skin-structure infections. When staphylococcal infections are localized and purulent, antibiotics are used as adjuncts to appropriate surgical measures.
Vancomycin hydrochloride has been reported to be effective alone or in combination with an aminoglycoside for endocarditis caused by S. viridans or S. bovis. For endocarditis caused by enterococci (e.g., E. faecalis), vancomycin hydrochloride has been reported to be effective only in combination with an aminoglycoside.
Vancomycin hydrochloride has been reported to be effective for the treatment of diphtheroid endocarditis. Vancomycin hydrochloride has been used successfully in combination with either rifampin, an aminoglycoside, or both in early-onset prosthetic valve endocarditis caused by S. epidermidis or diphtheroids.
Specimens for bacteriologic cultures should be obtained in order to isolate and identify causative organisms and to determine their susceptibilities to vancomycin hydrochloride.
The parenteral form of vancomycin hydrochloride may be administered orally for treatment of antibiotic-associated pseudomembranous colitis produced by C. difficile and for staphylococcal enterocolitis. Parenteral administration of vancomycin hydrochloride alone is of unproven benefit for these indications. Vancomycin hydrochloride is not effective by the oral route for other types of infection.
Although no controlled clinical efficacy studies have been conducted, intravenous vancomycin has been suggested by the American Heart Association and the American Dental Association as prophylaxis against bacterial endocarditis in penicillin-allergic patients who have congenital heart disease or rheumatic or other acquired valvular heart disease when these patients undergo dental procedures or surgical procedures of the upper respiratory tract.
NOTE: When selecting antibiotics for the prevention of bacterial endocarditis, the physician or dentist should read the full joint statement of the American Heart Association and the American Dental Association.3
To reduce the development of drug-resistant bacteria and maintain the effectiveness of vancomycin and other antibacterial drugs, vancomycin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
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NEWS HIGHLIGHTSMedia Articles Related to Vancomycin
Vancomycin-Resistant Enterococci (VRE)
Source: MedicineNet Endocarditis Specialty [2008.05.29]
Title: Vancomycin-Resistant Enterococci (VRE)
Category: Diseases and Conditions
Created: 5/8/2007
Last Editorial Review: 5/29/2008
MRSA Strain Linked To High Death Rates
Source: MRSA / Drug Resistance News From Medical News Today [2009.11.02]
A strain of MRSA that causes bloodstream infections is five times more lethal than other strains and has shown to have some resistance to the potent antibiotic drug vancomycin used to treat MRSA, according to a Henry Ford Hospital study. The study found that 50 percent of the patients infected with the strain died within 30 days compared to 11 percent of patients infected with other MRSA strains.
Zyvox® shows cost savings for treatment of skin infections
Source: The Doctors Lounge - Infections
Oral Zyvox® shows cost savings for outpatient treatment of skin and other infections when compared to vancomycin.
Published Studies Related to Vancomycin
Telavancin versus vancomycin for the treatment of complicated skin and skin-structure infections associated with surgical procedures. [2009.06]
BACKGROUND: We compared telavancin with vancomycin for the treatment of complicated skin and skin-structure infections (cSSSI) caused by Gram-positive bacteria... CONCLUSIONS: The efficacy of telavancin was at least equivalent to that of vancomycin for the treatment of cSSSI. These data suggest that telavancin may be a useful alternative for treatment of cSSSI caused by S. aureus, particularly MRSA.
The efficacy and safety of daptomycin vs. vancomycin for the treatment of cellulitis and erysipelas. [2009.03]
BACKGROUND: Results from previous trials suggest that daptomycin may result in faster clinical improvement than penicillinase-resistant penicillins or vancomycin for patients with complicated skin and skin structure infections. OBJECTIVE: The objective was to evaluate whether daptomycin treatment of cellulitis or erysipelas would result in faster resolution compared with vancomycin... CONCLUSIONS: There was no difference in the rate of resolution of cellulitis or erysipelas among patients treated with daptomycin or vancomycin. Daptomycin 4 mg/kg once daily appeared to be effective and safe for treating cellulitis or erysipelas.
Nitazoxanide versus vancomycin in Clostridium difficile infection: a randomized, double-blind study. [2009.02.15]
BACKGROUND: Vancomycin is the only US Food and Drug Administration-approved drug for treatment of Clostridium difficile infection (CDI). Metronidazole has been widely used for this purpose but may be inferior to vancomycin, especially for hospitalized patients with severe disease. We report a prospective, double-blind, randomized controlled trial comparing nitazoxanide with vancomycin for treatment of CDI... CONCLUSIONS: The small sample precludes conclusions about noninferiority of nitazoxanide to vancomycin. Nevertheless, this is the first recent randomized controlled trial to compare any antimicrobial agent other than metronidazole with vancomycin. Results suggest that nitazoxanide may be as effective as vancomycin in treating CDI. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00384527.
Nitazoxanide versus Vancomycin in Clostridium difficile Infection: A Randomized, Double-Blind Study. [2009.01.09]
Background...
Daptomycin versus vancomycin plus gentamicin for treatment of bacteraemia and endocarditis due to Staphylococcus aureus: subset analysis of patients infected with methicillin-resistant isolates. [2008.12]
OBJECTIVES: In a prospective, randomized trial, daptomycin was non-inferior to standard therapy for Staphylococcus aureus bacteraemia and right-sided endocarditis. Since rates of infection due to methicillin-resistant S. aureus (MRSA) infection are increasing and treatment outcomes for bacteraemia caused by MRSA are generally worse than those observed with methicillin-susceptible S. aureus bacteraemia, clinical characteristics and treatment results in the trial's pre-specified subset of patients with MRSA were analysed... CONCLUSIONS: Daptomycin was an effective alternative to vancomycin/gentamicin for MRSA bacteraemia or right-sided endocarditis.
Clinical Trials Related to Vancomycin
Trial of Prophylactic Versus Empirical Vancomycin for the Prevention of Streptococcal Sepsis After Hematopoietic Cell Transplantation [Completed]
This is a randomized 2-arm study to compare two different times of giving the drug
vancomycin. Half of the patients will begin vancomycin two days before a bone marrow
transplant. The other half will get it as soon as they have the first fever.
Streptococci are bacteria that live in one's mouth and gut. These bacteria can escape into
the blood when the lining of the mouth and gut weakens from cancer therapy. This can make
the person who is undergoing a bone marrow transplant very sick. All patients who get this
infection are treated with antibiotics. Vancomycin is one drug that is used to treat this
bloodstream infection once it is diagnosed. Studies have shown that giving vancomycin before
a bone marrow transplant seems to prevent this infection. However, giving vancomycin too
soon may increase the chance that the kidneys will be irritated. It may also increase the
chance that other bacteria will become resistant to this drug. We, the investigators at
Memorial Sloan-Kettering Cancer Center, do not know if waiting to start vancomycin until the
patient has a first fever can also prevent this infection.
Vancomycin Study: Treatment of Catheter Related Bloodstream Infection Caused by Coagulase Negative Staphylococcus [Completed]
Patients admitted into the Intensive Care Unit (ICU) have an intravenous (IV) catheter (small
plastic tube) placed in their vein. Very occasionally (4 times out of 100) the insertion of
an intravenous catheter may cause an infection in the blood. It has been shown that the
removal of the catheter and the insertion of a new one at a new site helps to get rid of this
infection. Sometimes, antibiotics are also given.
Vancomycin is the antibiotic given intravenously (into the vein) to treat these
catheter-related infections. At Vancouver General Hospital, some physicians may not give any
vancomycin at all whereas others may treat with intravenous (IV) vancomycin for one to
fourteen days.
Since there are a lack of data to support the length of IV vancomycin therapy, the
investigators would like to find out if two days of IV vancomycin are as good as seven days.
Therefore, the purpose of this study is to determine if two days of IV vancomycin are as good
as seven days for the treatment of catheter-related infections in the blood.
The Use of Antimicrobial Agents in the Inhibition of Mutans Streptococci in Children With Dental Caries [Completed]
The aim of the present study was to compare salivary MS levels in four different groups of
children with caries, that have been submitted to intraoral topical treatment with either
1,23% sodium fluoride, 1% chlorhexidine, 3% or 10% vancomycin, during 6 consecutive days.
This clinical trial was designed to test two different hypotheses. First, that topical
vancomycin would be more effective than chlorhexidine and sodium fluoride in salivary MS
reduction. Secondly, a 6-day antimicrobial treatment with either one of these agents would
produce a long lasting MS suppression, dispensing repeated antibacterial treatments.
Study Comparing CUBICINŽ (Daptomycin for Injection) With Vancomycin in Cellulitis or Erysipelas [Completed]
This study is designed to investigate the difference in speed and degree of symptom
resolution between daptomycin and vancomycin in subjects treated for cellulitis or erysipelas
by evaluation of the following parameters:
- Time to erythema margin cessation to progress
- Time to defervescence
- Time to hospital discharge following relief of the presenting cellulitis or erysipelas
- Degree of improvement of the following signs and symptom of cellulitis or erysipelas
including
- Degree of improvement of cellulitis-related pain and swelling as reported by subjects
Additionally, the difference in frequency of Adverse Events between daptomycin and vancomycin
will be described.
Comparative Study of Ceftaroline vs. Vancomycin Plus Aztreonam in Adult Subjects With Complicated Skin Infections [Completed]
The purpose of this study is to determine whether ceftaroline is effective and safe in the
treatment of complicated skin infections in adults.
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