Table 1.

CDC based agreed guidelines for prescribing or withholding.

Intervention with vancomycin (or teicoplanin) considered appropriate
1 Treatment of infections (not colonization) attributed to β-lactam resistant Gram +ve organisms (mainly MRSA & MRSE, viz: (a) confirmed by culture (b) suspected prosthetic valve IE (awaiting microbiology)
2 Empiric treatment of fever in (a) neutropenic patients and (b) ICU patients: whenever they have (i) central line inflammation, or (ii) gram +ve organism revealed by blood culture or appropriate smear* (until confirmed to be b-lactam sensitive); otherwise consider appropriate alternative therapy such as cloxacillin**
3 Treatment of ‘Antibiotic Colitis’ not responding to metronidazole or if it is life-threatening
4 Treatment of serious gram +ve infections if there is β-lactam ‘hypersensitivity’
5 As an additional antibiotic in the empirical treatment of presumed pneumococcal meningitis
6 Prophylaxis against IE during potentially bacteraemic procedures/episodes in certain high risk patients (with prosthetic heart valves/devices, vascular shunts or prior IE) and hypersensitivity or recent exposure to penicillin
7 Prophylaxis against wound infection during major surgery for insertion of foreign body (prosthetic valve, shunt, joint)
Intervention with vancomycin (or teicoplanin) considered inappropriate
1 If only one blood culture is +ve for S. epidermidis; two cultures should normally be taken from different sites at around the same time
2 Empiric intervention in febrile neutropenic patient, unless there is ‘central’ i.v line inflammation
3 Continued empirical treatment of ‘sepsis’/fever (> 48 h), if cultures yield no β-lactam resistant gram +ve microbe
4 Against β-lactam-sensitive microbial infections in renal failure patients
5 Primary treatment (orally) of ‘antibiotic’ colitis; metronidazole preferred, unless life-threatening
6 Eradication of MRSA from colonized surfaces and/or any other form of topical application/irrigation
7 Routine prophylaxis against infection/colonization: (i) systemically with central or peripheral lines (ii) locally (antibiotic lock) (iii) during surgery (iv) for gut decontamination (v) for CAPD/–haemodialysis, or Tenckhoff insertion (vi) for low birth weight infant

^*If from pus, deep wound swab or tissues

^**Vancomycin may be considered for patient who is seriously ill or deteriorating. (Adapted from CDC guidelines (2), which did not refer to telcoplanin).