Vancomycin IV

Acceptable Empiric Use

• Treatment of suspected community-or nosocomial-acquired bacterial meningitis.

• Treatment of healthcare-associated (including ventilator-associated) pneumonia.

• Treatment of peritoneal dialysis-related peritonitis in a severely ill patient.

• Treatment ofsepsis in a patient at risk for MRSA bacteremia [catheter in place, indwelling hardware, known MRSA colonization, transfer from a nursing home or subacute facility, recent (within 3 months) or current prolonged hospitalization >2 weeks, hemodialysis].

• Treatment of surgical-site infection following placement of hardware.

• Treatment of severe diabetic foot infection in a patient at risk for MRSA.

• Treatment of necrotizing fasciitis.

• Treatment of suspected endocarditis in a moderately or severely ill patient after appropriate blood cultures are obtained.

• Treatment of Gram-positive cocci in clusters in ≥ 1 set of blood cultures in a moderately or severely ill patient.

• Treatment of Gram-positive cocci in clusters or chains in ≥ 2 sets of blood cultures in any patient.
  Note: empiric therapy should be discontinued within 72 hours if criteria for definitive therapy (listed below) are not met:

Acceptable Use for Definitive Intravenous Therapy
Proven infection with beta-lactam resistant organisms:

• MRSA

• Methicillin-resistant coagulase-negative staphylococcus

• Ampicillin-resistant enterococcus (if susceptible)

• Ceftriaxone-resistant S. pneumoniae (CSF only)

Treatment of infections caused by Gram-positive organisms in patients who have severe allergic reactions to beta-lactam antibiotics (see discussion of penicillin allergy).

Acceptable Use for Definitive Oral Therapy
Clostridium difficile infection (see CDI section)

Acceptable Use for Prophylaxis
Prophylaxis for cardiac, vascular, or orthopedic (jointreplacement, spinal fusion, ORIF only) surgery with a documented reason in the chart or in patients with severe beta-lactam allergy (no more than one pre-op and one post-op dose).