Vancomycin should not be used when not clearly indicated. This is needed to reduce the emergence and spread of drug-resistant bacteria.


Situations when vancomycin use should be avoided:

(1) surgical prophylaxis when the patient does not have a life-threatening allergy to beta-lactam antibiotics or if an alternative antibiotic is available

(2) routine prophylaxis in a low-birth-weight infant

(3) routine prophylaxis in a patient on dialysis

(4) routine prophylaxis in a patient with neutropenia

(5) routine prophylaxis in a patient with a central venous catheter


(6) empirical treatment of a febrile patient with neutropenia who is not at high risk for resistant Gram-positive infection

(7) empirical treatment of a febrile low-birth-weight infant


(8) decontamination of the gastrointestinal tract

(9) use as the first line drug for patients with Clostridium difficile colitis


(10) patient with a single blood culture positive for coagulase-positive staphylococci

(11) to eradicate colonization by methicillin-resistant Staphylococcus aureus

(12) use to treat a Gram-positive infection caused by organisms that are not drug-resistant

(13) use to treat an infection on dialysis solely on the basis of convenience

(14) for topical application or irrigation


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