Prophylactic use of vancomycin in adult cardiology and cardiac surgery.
The recent appearance of Staphylococcus aureus and Staphylococcus epidermidis strains that have reduced susceptibility to vancomycin, and the spread of vancomycin-resistant enterococci, raise the specter of endovascular infections that will be difficult or impossible to cure with available drugs. We review issues concerning the prophylactic use of vancomycin in adult cardiology and cardiac surgery with special attention to dosing and indications. There is no indication for the routine use of prophylactic vancomycin in pacemaker implantations, cardiac catheterization, and transesophageal echocardiography. In institutions with a high incidence of methicillin-resistant S. aureus and S. epidermidis, vancomycin may be used for antibiotic prophylaxis in place of cephalosporins for pacemaker or defibrillator implantation. The strongest evidence in support of the prophylactic use of vancomycin is during cardiac surgeries, particularly valvular surgeries in institutions with a high prevalence of methicillin-resistant S. aureus and S. epidermidis. When vancomycin is used prior to open heart surgery, the dose should be 15 mg/kg rather than the standard 1 g dose that is often recommended in the literature and used by 85% of institutional pharmacists who responded to our survey. Cardiologists and cardiac surgeons should assume leadership roles in promoting its responsible use.
Movahed
Mohammad-Reza
MR
Department of Medicine, Division of Cardiology, University of California-Irvine Medical Center, Building 53, Route 81, Room 100, 101 The City Drive South, Orange, CA 92868-4080, USA. mmovahed@uci.edu
Kasravi
Babak
B
Bryan
Charles S
CS
D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D016106:Methicillin Resistance; D013203:Staphylococcal Infections / Q000209:etiology / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000472:pathogenicity*; D013212:Staphylococcus epidermidis / Q000472:pathogenicity*; D014640:Vancomycin / Q000008:administration & dosage* / Q000627:therapeutic use*; D020713:Vancomycin Resistance
D000900:Anti-Bacterial Agents; D014640:Vancomycin