From the Guidelines
Vancomycin can be used for certain types of pneumonia, particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA) or other resistant gram-positive bacteria, at a dose of 15 mg/kg every 12 h, adjusted based on levels, as recommended by the American Thoracic Society and Infectious Diseases Society of America 1.
Key Considerations
- Vancomycin is not a first-line treatment for most community-acquired pneumonia cases but is reserved for specific situations where resistant organisms are suspected or confirmed.
- Treatment duration is typically 7-14 days depending on severity and clinical response.
- When using vancomycin, monitoring of trough levels (typically aiming for 15-20 μg/mL for pneumonia), kidney function, and watching for side effects like "red man syndrome" (which can be minimized by slow infusion) is essential.
- Alternative antibiotics may be more appropriate depending on the specific pneumonia type and suspected pathogens.
Important Details
- The most recent guidelines recommend abandoning the use of the prior categorization of healthcare-associated pneumonia (HCAP) to guide selection of extended antibiotic coverage in adults with CAP 1.
- Empiric treatment options for MRSA include vancomycin or linezolid, and the choice of antibiotic should be based on local validated risk factors for either pathogen 1.
- Vancomycin has poor penetration into lung tissue, which is why higher doses and careful monitoring are needed for pneumonia treatment 1.
Monitoring and Adjustments
- Trough vancomycin monitoring is recommended for serious infections and patients who are morbidly obese, have renal dysfunction, or have fluctuating volumes of distribution 1.
- Vancomycin trough concentrations of 15-20 μg/mL are recommended for serious infections, including pneumonia 1.
- Adjustments to vancomycin dosing should be based on actual body weight and estimated creatinine clearance, not to exceed 2 g per dose 1.
From the Research
Vancomycin for Pneumonia
- Vancomycin has been recommended as the treatment of choice for methicillin-resistant Staphylococcus aureus (MRSA) pneumonia with a desired trough concentration of 15 to 20 mg/L 2.
- A study found that a vancomycin regimen of 1 g i.v. every 12 hours in critically ill trauma patients with MRSA pneumonia and normal renal function is unlikely to achieve trough concentrations of 15 to 20 mg/L, and doses of at least 1 g i.v. every 8 hours are needed 2.
- Another study compared linezolid and vancomycin for the treatment of MRSA pneumonia and found that linezolid was superior to vancomycin in terms of clinical success and survival 3.
- A retrospective cohort analysis found that baseline renal function did not impact the differences in efficacy or nephrotoxicity with treatment of linezolid versus vancomycin in MRSA pneumonia 4.
- A review of pharmacologic treatment options for nosocomial pneumonia involving MRSA found that vancomycin has been the drug of choice for MRSA infections for many years, but linezolid may be superior to vancomycin in the treatment of MRSA nosocomial pneumonia 5.
- A meta-analysis of vancomycin versus linezolid in pneumonia with proven MRSA found that linezolid was associated with increased clinical cure and microbiological eradication rates compared to vancomycin 6.
Dosage and Administration
- The recommended dosage of vancomycin for MRSA pneumonia is 1 g i.v. every 8 hours, with a desired trough concentration of 15 to 20 mg/L 2.
- The dosage of vancomycin may need to be adjusted based on renal function and other factors to achieve optimal trough concentrations 2, 4.
Comparison with Linezolid
- Linezolid has been found to be superior to vancomycin in terms of clinical success and survival in the treatment of MRSA pneumonia 3, 6.
- Linezolid may be associated with fewer adverse events, such as nephrotoxicity, compared to vancomycin 3, 4.
- The choice between vancomycin and linezolid for the treatment of MRSA pneumonia should be based on individual patient factors, such as renal function and potential for adverse events 4, 5.