title: The role of vancomycin in the treatment paradigm.
abstract: Vancomycin was introduced in the United States in 1956 as a possible treatment for infections due to penicillin-resistant Staphylococcus aureus, but it was not used widely because of toxicity and the nearly simultaneous development of semisynthetic antibiotics and cephalosporins. Thus, its main indication was the treatment of serious gram-positive infections in penicillin-allergic patients. For susceptible strains of S. aureus, vancomycin was more rapidly bactericidal than penicillin, nafcillin, or cefazolin, and, in a rabbit model of S. aureus endocarditis, sterilization of vegetations was more rapid with vancomycin. In clinical practice, however, nafcillin remained the treatment of choice for staphylococcal bacteremia, largely because it had failure rates of only 4%. With the appearance of methicillin-resistant S. aureus and coagulase-negative staphylococci, vancomycin became the drug of choice for these infections. Recently, the efficacy of vancomycin has been questioned because of vancomycin's increasing minimum inhibitory concentrations among staphylococci, poor tissue penetration, and apparently slower bacterial killing than previously was recognized.
authors.affiliation: Infectious Disease Section, Veterans Affairs Medical Center, Boise, Idaho 83702, USA. dlsteven@mindspring.com
authors.forename: Dennis L
authors.initials: DL
authors.lastname: Stevens
mesh_terms: D000900:Anti-Bacterial Agents / Q000097:blood / Q000494:pharmacology* / Q000627:therapeutic use*; D016470:Bacteremia / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D004359:Drug Therapy, Combination; D004697:Endocarditis, Bacterial / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D008826:Microbial Sensitivity Tests; D011023:Pneumonia, Staphylococcal / Q000188:drug therapy; D018461:Soft Tissue Infections / Q000188:drug therapy / Q000382:microbiology; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy*; D013207:Staphylococcal Skin Infections / Q000188:drug therapy / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects*; D017211:Treatment Failure; D014640:Vancomycin / Q000097:blood / Q000494:pharmacology* / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin