Editing Vancomycin (section)

==Medical uses==
Vancomycin is indicated for the treatment of serious, life-threatening infections by [[Gram-positive]] bacteria of both [[Aerobic bacteria|aerobic]] and [[Anaerobic bacteria|anaerobic]] types<ref name="B978">{{cite book|doi=10.1016/B978-0-444-63749-9.00008-6 |title=From Natural Products to Drugs |series=Studies in Natural Products Chemistry |year=2016 | vauthors = Biondi S, Chugunova E, Panunzio M |volume=50 |pages=249–297 |isbn=978-0-444-63749-9 }}</ref> that are unresponsive to other antibiotics.<ref name="pmid31545906">{{cite journal |vauthors=Mühlberg E, Umstätter F, Kleist C, Domhan C, Mier W, Uhl P |title=Renaissance of vancomycin: approaches for breaking antibiotic resistance in multidrug-resistant bacteria |journal=Can J Microbiol |volume=66 |issue=1 |pages=11–16 |date=January 2020 |pmid=31545906 |doi=10.1139/cjm-2019-0309|hdl=1807/96894 |s2cid=202745549 |hdl-access=free }}</ref><ref name="pmid31899563">{{cite journal |vauthors=Stogios PJ, Savchenko A |title=Molecular mechanisms of vancomycin resistance |journal=Protein Sci |volume=29 |issue=3 |pages=654–669 |date=March 2020 |pmid=31899563 |pmc=7020976 |doi=10.1002/pro.3819 }}</ref><ref name="pmid25753888">{{cite journal |vauthors=Bruniera FR, Ferreira FM, Saviolli LR, Bacci MR, Feder D, da Luz Gonçalves Pedreira M, Sorgini Peterlini MA, Azzalis LA, Campos Junqueira VB, Fonseca FL |title=The use of vancomycin with its therapeutic and adverse effects: a review |journal=Eur Rev Med Pharmacol Sci |volume=19 |issue=4 |pages=694–700 |date=February 2015 |pmid=25753888 }}</ref>

The increasing emergence of [[Vancomycin-resistant Enterococcus|vancomycin-resistant enterococci]] (VRE) has resulted in the development of guidelines for use by the [[Centers for Disease Control]] Hospital Infection Control Practices Advisory Committee. These guidelines restrict use of vancomycin to these indications:<ref name="AMH2006">{{cite book | veditors = Rossi S | title = [[Australian Medicines Handbook]] | location = Adelaide | publisher = Australian Medicines Handbook | date = 2006 | isbn = 0-9757919-2-3 }}</ref><ref name=cdc>{{cite journal | title = Recommendations for preventing the spread of vancomycin resistance. Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC) | journal = MMWR. Recommendations and Reports | volume = 44 | issue = RR-12 | pages = 1–13 | date = September 1995 | pmid = 7565541 | url = http://wonder.cdc.gov/wonder/prevguid/m0039349/m0039349.asp | url-status = live | archive-url = https://web.archive.org/web/20060923012326/http://wonder.cdc.gov/wonder/prevguid/m0039349/m0039349.asp | archive-date = 23 September 2006 }}</ref>
* treatment of serious infections caused by susceptible organisms [[Antimicrobial resistance|resistant]] to penicillins, such as [[MRSA|methicillin-resistant ''S.&nbsp;aureus'']] (MRSA) and multidrug-resistant ''[[Staphylococcus epidermidis|S. epidermidis]]'' (MRSE),
* treatment of infections in individuals with serious allergy to [[Side effects of penicillin|penicillins]],
* treatment of [[pseudomembranous colitis]] caused by ''C.&nbsp;difficile''; in particular, in cases of relapse or where the infection is unresponsive to [[metronidazole]] treatment (for this indication, vancomycin is given orally rather than intravenously),
* treatment of infections caused by Gram-positive microorganisms in patients with serious allergies to beta-lactam antimicrobials,<ref name=cdc/>
* antibacterial prophylaxis for [[endocarditis]] after certain procedures in penicillin-[[hypersensitivity|hypersensitive]] people at high risk,<ref name=cdc/>
* surgical prophylaxis for major procedures involving implantation of [[prosthesis|prostheses]] in institutions with a high rate of MRSA or MRSE,<ref name=cdc/>
* early in treatment as an [[empiric therapy|empiric antibiotic]] for possible MRSA infection while waiting for culture identification of the infecting organism,
* halting the progression of [[primary sclerosing cholangitis]] and preventing symptoms; vancomycin does not cure the patient and success is limited,
* treatment of [[endophthalmitis]] by intravitreal injection for [[Gram-positive bacteria|Gram-positive]] bacteria coverage;<ref name="pmid10691328">{{cite journal | vauthors = Lifshitz T, Lapid-Gortzak R, Finkelman Y, Klemperer I | title = Vancomycin and ceftazidime incompatibility upon intravitreal injection | journal = The British Journal of Ophthalmology | volume = 84 | issue = 1 | pages = 117–8 | date = January 2000 | pmid = 10691328 | pmc = 1723217 | doi = 10.1136/bjo.84.1.117a }}</ref> it has been used to prevent the condition but is not recommended due to the risk of side effects.<ref name="Office of the Commissioner">{{cite web|author=Office of the Commissioner|title=Safety Alerts for Human Medical Products - Intraocular Injections of a Compounded Triamcinolone, Moxifloxacin, and Vancomycin (TMV) Formulation: FDA Statement - Case of Hemorrhagic Occlusive Retinal Vasculitis|url=https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm578743.htm|website=www.fda.gov|access-date=6 October 2017|language=en|archive-date=3 October 2017|archive-url=https://web.archive.org/web/20171003211204/https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm578743.htm|url-status=dead}}</ref>

=== Spectrum of susceptibility ===
Vancomycin is a last-resort medication for the treatment of [[sepsis]] and [[lower respiratory tract]], skin, and bone infections caused by Gram-positive bacteria. The [[minimum inhibitory concentration]] susceptibility data for a few medically significant bacteria are:<ref name="Vancomycin-TOKU-E">{{cite web |url=http://antibiotics.toku-e.com/antimicrobial_1182_1.html |title=Vancomycin (Vancocyn, Lyphocin) &#124; the Antimicrobial Index Knowledgebase - TOKU-E |access-date=26 February 2014 |url-status=live |archive-url=https://web.archive.org/web/20140227000847/http://antibiotics.toku-e.com/antimicrobial_1182_1.html |archive-date=27 February 2014 }}{{full citation needed|date=November 2014}}</ref>
* ''[[Staphylococcus aureus|S. aureus]]'': 0.25&nbsp;μg/mL to 4.0&nbsp;μg/mL
* ''S. aureus'' ([[Methicillin-resistant Staphylococcus aureus|methicillin resistant or MRSA]]): 1&nbsp;μg/mL to 138&nbsp;μg/mL
* ''[[Staphylococcus epidermidis|S. epidermidis]]'': ≤0.12&nbsp;μg/mL to 6.25&nbsp;μg/mL