Laurie L. Briceland, PharmD

Disclosures

October 13, 2005

Question

How long should a patient receive intermittent intravenous vancomycin therapy? I have a patient who has been receiving 1 g of vancomycin every 60 hours for 3.5 months. His peak and trough are within normal limits. How much longer can he stay on this therapy?

Response from Laurie L. Briceland, PharmD

The answer depends on a number of patient factors. Vancomycin is indicated for use in a number of specified conditions, including infection due to beta-lactam-resistant gram-positive organisms; documented urticarial or anaphylactic reaction to beta-lactam antibiotics; and neutropenia with suspected catheter infection.[1] It is also indicated for empiric use in cardiac surgery during MRSA infection cluster and for initial empiric therapy in select cases, such as a recent hospital readmission.[1]

For most infections, 15 days of therapy or less is sufficient, and anything longer would be considered inappropriate. In neutropenia, the appropriate duration of therapy is dictated by defervescence and return of the neutrophil count, so therapy could span several weeks in profound neutropenia.

For deep-seated infections such as bacterial endocarditis or osteomyelitis, 8 weeks is considered the usual duration of therapy unless a justifiable exception exists, such as in the case of a patient who has a removable focus of infection (eg, prosthesis) but is inoperable.[2]

For all indications, the goal should be to determine the shortest acceptable duration of therapy, as significant vancomycin resistance could develop, thus limiting its usefulness in the given patient. This also could pose a public health threat, should the resistant organism spread to others.[3] Thus, the answer to this question depends on all of these factors.

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