Therapeutic monitoring of vancomycin in adult patients: A consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists

Vancomycin is a glycopeptide antibiotic that has been in clinical use for nearly 50 years as a penicillin alternative to treat penicillinase-producing strains of Staphylococcus aureus. It is one of the most widely used antibiotics in the United States for the treatment of serious gram-positive infections involving methicillin-resistant S. aureus (MRSA).1 Early use of vancomycin was associated with a number of adverse effects, including infusion-related toxicities, nephrotoxicity, and possible ototoxicity. Upon further investigation, it appears that the impurities in early formulations of vancomycin caused many of these adverse events.1–4 Its overall use was curtailed significantly with the development of semisynthetic penicillins (e.g., methicillin, oxacillin, nafcillin) that were considered less toxic.1–4 However, the steady rise in the number of MRSA infections since the early 1980s has once again brought vancomycin into the forefront as the primary treatment for infections caused by this organism....