From the Guidelines
Vancomycin is effective against Streptococcus species, including Streptococcus pneumoniae, Group A Streptococcus (S. pyogenes), Group B Streptococcus, and viridans group streptococci, and is recommended for use in patients with severe infections or those who are allergic to penicillin. According to the practice guidelines for the diagnosis and management of skin and soft tissue infections, vancomycin is recommended for patients whose cellulitis is associated with penetrating trauma, evidence of MRSA infection elsewhere, nasal colonization with MRSA, injection drug use, purulent drainage, or SIRS (severe nonpurulent) 1. Vancomycin works by inhibiting bacterial cell wall synthesis by binding to the D-Ala-D-Ala terminus of peptidoglycan precursors, preventing cross-linking of the peptidoglycan layer. For serious streptococcal infections, vancomycin is typically dosed at 15-20 mg/kg IV every 8-12 hours (not to exceed 2g per dose), with adjustments based on renal function and therapeutic drug monitoring 1.
Key Points to Consider
- Vancomycin is effective against a wide range of Streptococcus species
- It is recommended for use in patients with severe infections or those who are allergic to penicillin
- The dosage of vancomycin should be adjusted based on renal function and therapeutic drug monitoring
- Target trough levels are usually 10-15 μg/mL for most infections and 15-20 μg/mL for more severe infections like endocarditis
Clinical Considerations
- Vancomycin is particularly valuable for treating streptococcal infections in patients with severe penicillin allergies or when dealing with resistant strains
- Beta-lactam antibiotics like penicillin or ceftriaxone are generally preferred first-line treatments when the organism is susceptible, as they have better tissue penetration and clinical outcomes
- Vancomycin should be used in combination with other antibiotics, such as piperacillin-tazobactam or imipenem-meropenem, for severe infections 1
From the FDA Drug Label
Vancomycin has been shown to be active against most strains of the following microorganisms, both in vitro and in clinical infections... Streptococcus bovis, Viridans group streptococci Vancomycin exhibits in vitro MIC's of 1 mcg/mL or less against most (≥90%) strains of streptococci listed below... Streptococcus pyogenes, Streptococcus pneumoniae (including penicillin-resistant strains), Streptococcus agalactiae
Vancomycin covers Streptococcus, including:
- Streptococcus bovis
- Viridans group streptococci
- Streptococcus pyogenes
- Streptococcus pneumoniae (including penicillin-resistant strains)
- Streptococcus agalactiae 2
From the Research
Vancomycin Coverage for Streptococcus
- Vancomycin is primarily used to treat infections caused by methicillin-resistant Staphylococcus aureus (MRSA) 3, 4, 5, 6.
- The provided studies do not specifically address the effectiveness of vancomycin against Streptococcus infections.
- However, it is known that vancomycin has a broad spectrum of activity against Gram-positive bacteria, including some species of Streptococcus 6.
- Vancomycin is effective against Streptococcus pneumoniae, Streptococcus pyogenes, and other streptococcal species, but its use is typically reserved for severe or resistant infections 6.
Limitations and Considerations
- The studies provided focus on the treatment of MRSA infections, and there is limited information on the use of vancomycin for Streptococcus infections 3, 4, 5, 7.
- Vancomycin resistance has been reported in some species of Streptococcus, which may limit its effectiveness in certain cases 6.
- The choice of antibiotic for Streptococcus infections depends on various factors, including the specific species, severity of infection, and local resistance patterns 6.