Clinical usefulness of vancomycin.
The antibacterial spectrum, pharmacokinetics, and clinical uses of vancomycin are reviewed. Vancomycin interferes with peptidoglycan biosynthesis in multiplying organisms and is bactericidal. It is supplied as the hydrochloride salt and is available in 500-mg ampuls. Vancomycin is usually administered intravenously or orally. I.V. vancomycin should be administered slowly (over 30--60 min) and in an adequate volume (100--250 ml) of 5% dextrose injection. Usual adult dose is 500 mg every six hours or 1 g every 12 hours. Serum vancomycin kinetics are best explained on the basis of a two- or three-compartment open model. Vancomycin is almost completely eliminated through the kidneys. Mean vancomycin concentrations in the presence of inflamed meninges, pleural fluid, pericardial fluid, ascitic fluid, synovial fluid, and bile are approximately 15% of the serum concentrations. Vancomycin is used prophylactically to prevent infections caused by gram-positive cocci. Vancomycin is an ideal drug for prophylaxis in prosthetic implant surgery because of its long serum half-life and activity against Staphylococcus epidermidis and Staph. aureus. Vancomycin has been used in the prevention and treatment of shunt infection in hemodialysis patients. It can be used adjunctly with a number of antibiotics to treat a variety of bacterial infections. Vancomycin is recognized as one of the most potent antistaphylococcal drugs available. It is the drug-of-choice in the treatment of serious methicillin-resistant Staph. aureus infections. It is the preferred therapy for Clostridium difficile (antibiotic-associated) colitis.(ABSTRACT TRUNCATED AT 250 WORDS)