Análisis crítico de un antimicrobiano sub-óptimo, de frecuente sobre-utilización e inadecuada dosificación: Vancomicina

Resumen

Background: Vancomycin, standard parenteral therapy for beta-lactam resistant Staphylococci  (aureus [(MRSA] and coagulase negative [CNS]) and Enterococci, frequent agents of nosocomial infections, is extensively used empirically in that setting. However, its pharmacological weakness, narrow therapeutic margin and poorly predictable pharmacokinetics, make it a suboptimal drug according to contemporary criteria. Vancomycin is overutilized due to both, overestimation of bacterial infections and, in genuine cases, overestimation of the etiological role of these resistant cocci, either nosocomially or community acquired. New threats  narrow further its therapeutic role: poorer outcomes in infections  with higher vancomycin MIC and resistance by Enterococci. It is frequently given at inappropriate dosage and intervals, failing to: give loading dose when recommended, measure blood levels, adjust dosing to changing renal function and no discontinuation when not necessary. Newer anti staphylococcal drugs haven´t replaced completely the role of vancomycin, which maintains its usefulness in contemporary medicine.

Conclusion: Understanding the strengths and weaknesses of vancomycin, the current epidemiology and microbiology of infections for which it may be indicated, as well as the proper administration and monitoring, together with a prudent and selective indication will allow to preserve its present and future utility in the changing medical scenario. This review has that purpose.