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  • SHC ASP Vancomycin Use Guide2

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    This document provides guidelines for appropriate use and discontinuation of vancomycin at Stanford Health Care. It outlines situations where vancomycin is indicated, such as documented infections by MRSA, MSSA, enterococcus, or streptococcus. It recommends discontinuing vancomycin within 72 hours if cultures are negative for organisms requiring it or if the culture is positive for an organism that is susceptible to beta-lactams. The document provides contact information for infectious disease specialists and references guidelines from IDSA and ASP for therapeutic vancomycin monitoring.

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    This document provides guidelines for appropriate use and discontinuation of vancomycin at Stanford Health Care. It outlines situations where vancomycin is indicated, such as documented infections by MRSA, MSSA, enterococcus, or streptococcus. It recommends discontinuing vancomycin within 72 hours if cultures are negative for organisms requiring it or if the culture is positive for an organism that is susceptible to beta-lactams. The document provides contact information for infectious disease specialists and references guidelines from IDSA and ASP for therapeutic vancomycin monitoring.

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    © All Rights Reserved
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    8 views2 pages

    SHC ASP Vancomycin Use Guide2

    Uploaded by

    Nisa
    This document provides guidelines for appropriate use and discontinuation of vancomycin at Stanford Health Care. It outlines situations where vancomycin is indicated, such as documented infections by MRSA, MSSA, enterococcus, or streptococcus. It recommends discontinuing vancomycin within 72 hours if cultures are negative for organisms requiring it or if the culture is positive for an organism that is susceptible to beta-lactams. The document provides contact information for infectious disease specialists and references guidelines from IDSA and ASP for therapeutic vancomycin monitoring.

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    © All Rights Reserved
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    of 2

    Stanford Antimicrobial Safety and Sustainability Program

    Revision date 5/14/2017

    SHC Vancomycin De-Escalation Guide

    Appropriate Vancomycin Use:

    1. Documented infection/culture positive with:


    a. MRSA/CoNS (MecA positive)
    b. Other gram-positive infection for which vancomycin is a drug of choice
    - E.g. enterococcus (non-respiratory tract) that is ampicillin-resistant and
    vancomycin-susceptible
    - E.g. streptococcus that is penicillin-resistant and cephalosporin-resistant
    2. Documented infection/no site cultures available and:
    a. Severe skin or soft infection
    b. Osteoarticular infection
    c. Other serious deep infection (e.g. epidural abscess)
    3. Severe beta-lactam allergy and documented gram-positive infection
    a. Severe allergy includes history of type I immediate hypersensitivity (e.g., urticaria,
    angioedema, anaphylaxis, bronchospasm)
    b. For a history of other serious reactions (Type II, III, or IV – e.g., hemolytic anemia,
    thrombocytopenia, serum sickness, erythema multiforme, SJS/TEN, DRESS, etc), avoid
    the specifically implicated drug, but others in the class may be used (except for
    cephalosporins with same R group side chain). Consider consulting Allergy &
    Immunology.

    Discontinuation of vancomycin at 72 hours or earlier:

    1. Cultures negative for organisms indicating need for vancomycin


    a. Pneumonia when respiratory culture not available and MRSA nares screen is negative
    b. Includes those with febrile neutropenia
    c. Exceptions – see #2 above
    2. Culture positive with gram positive organism susceptible to beta-lactams
    a. MSSA/CoNS (MecA negative)
    b. Enterococcus that is ampicillin susceptible
    i. Respiratory culture positive with enterococcus is most commonly a colonizer and
    does not require treatment
    c. Streptococcus that is penicillin- susceptible or cephalosporin-susceptible

    Contact Information: Antimicrobial Stewardship Program: x11908


    General Infectious Disease pager: 24308
    Immunocompromised Host Infectious Disease pager: 17000
    ICU / LVAD Infectious Disease pager: 27190
    Lung Transplant / Infusion Treatment Area Infectious Disease pager: 17008

    References: Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, Kaplan SL, Karchmer AW, Levine DP, Murray BE, Rybak
    MJ. Clinical practice guidelines by the IDSA for the treatment of methicillin-resistant Staphylococcus aureus infections in
    adults and children. CID. 2011 Feb 1;52(3):e18-55.
    Rybak M, et al. Therapeutic monitoring of vancomycin in adult patients: A consensus review of the American Society of
    Health-System Pharmacists, the IDSA/SIDP; Am J Health-Syst Pharm. 2009;66:82-98.
    Stanford Antimicrobial Safety and Sustainability Program
    Revision date 5/14/2017

    Document Information
    A. Original Author/Date: ASP/SASS team 9/2016
    B. Gatekeeper: Antimicrobial Stewardship Program
    C. Review and Renewal Requirement
    This document will be reviewed every three years and as required by change of law or
    practice
    D. Revision/Review History: 04/2017, 05/2017
    E. Approvals
    1. Antimicrobial Subcommittee 3/2017, 8/17/2017
    2. P&T 9/15/2017

    This document is intended only for the internal use of Stanford Health Care (SHC). It may not be copied or otherwise used, in whole, or in
    part, without the express written consent of SHC. Any external use of this document is on an AS IS basis, and SHC shall not be
    responsible for any external use.

    Stanford Health Care


    Stanford, CA 94305

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