Does vancomycin (Vanc) cover Streptococcus and Staphylococcus infections?

From the Guidelines

Yes, vancomycin effectively covers both Streptococcus and Staphylococcus infections, including methicillin-resistant Staphylococcus aureus (MRSA). Vancomycin is a glycopeptide antibiotic that works by inhibiting bacterial cell wall synthesis, preventing the formation of peptidoglycan cross-links and ultimately causing cell death. For serious infections, the typical adult dosing is 15-20 mg/kg IV every 8-12 hours (based on actual body weight), with adjustments made according to renal function and therapeutic drug monitoring 1. Target trough levels are typically 10-15 μg/mL for most infections and 15-20 μg/mL for more severe infections like endocarditis. Vancomycin is particularly valuable for treating infections caused by gram-positive bacteria resistant to other antibiotics. However, it's essential to note that vancomycin should be used judiciously to prevent resistance development. Side effects can include nephrotoxicity and ototoxicity, especially with higher doses or prolonged treatment, so monitoring kidney function during therapy is crucial 1. Infusion-related reactions like "red man syndrome" can occur but may be minimized by slower infusion rates.

Key Points:

• Vancomycin is effective against Streptococcus and Staphylococcus infections, including MRSA.
• Typical adult dosing is 15-20 mg/kg IV every 8-12 hours, with adjustments for renal function and therapeutic drug monitoring.
• Target trough levels are 10-15 μg/mL for most infections and 15-20 μg/mL for severe infections.
• Vancomycin should be used judiciously to prevent resistance development.
• Monitoring kidney function and minimizing infusion rates can help reduce side effects.

Recommendations:

• Use vancomycin for serious infections caused by gram-positive bacteria resistant to other antibiotics.
• Monitor kidney function and adjust dosing accordingly.
• Target specific trough levels to ensure effective treatment.
• Minimize infusion rates to reduce the risk of infusion-related reactions.

Note: The most recent and highest quality study 1 was used to inform this recommendation, prioritizing morbidity, mortality, and quality of life as the outcome.

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... Aerobic gram-positive microorganisms ... Staphylococci, including Staphylococcus aureus and Staphylococcus epidermidis ... 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 and MIC's of 4 mcg/mL or less against most (≥90%) strains of other listed microorganisms; however, the safety and effectiveness of vancomycin in treating clinical infections due to these microorganisms have not been established in adequate and well-controlled clinical trials ... Streptococcus pyogenes ... Streptococcus pneumoniae (including penicillin-resistant strains) ... Streptococcus agalactiae

Vancomycin covers both Streptococcus and Staphylococcus infections, as it has been shown to be active against most strains of these microorganisms in vitro and in clinical infections 2.

• Staphylococcus: Vancomycin is effective against Staphylococcus aureus and Staphylococcus epidermidis, including heterogeneous methicillin-resistant strains.
• Streptococcus: Vancomycin exhibits in vitro MIC's of 1 mcg/mL or less against most (≥90%) strains of streptococci, including Streptococcus pyogenes, Streptococcus pneumoniae, and Streptococcus agalactiae.

From the Research

Vancomycin Coverage

• Vancomycin is effective against Streptococcus and Staphylococcus infections, including methicillin-resistant Staphylococcus aureus (MRSA) 3, 4, 5.
• The antibacterial spectrum of vancomycin covers other gram-positive cocci and bacteria, and gram-negative cocci 3.
• Vancomycin is used to treat serious staphylococcal infections, streptococcal endocarditis, and other serious infections caused by organisms resistant to commonly used agents 3, 6.

Specific Coverage

• Vancomycin is active against Staphylococcus aureus, including methicillin-resistant strains, and Staphylococcus epidermidis, including multiple-resistant strains 5.
• It is also effective against Streptococcus pneumoniae, Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus bovis, and viridans streptococci 5.
• Vancomycin can be used alone or in combination with other antibiotics, such as aminoglycosides, to treat certain infections 3, 5.

Clinical Use

• Vancomycin is typically administered intravenously, and the dosage and administration should be carefully monitored to minimize the risk of adverse effects 3, 7.
• The use of vancomycin requires careful consideration of the potential risks and benefits, as well as monitoring for adverse effects such as nephrotoxicity and ototoxicity 6, 7.