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PubMed1987

Systemic absorption of oral vancomycin in patients with renal insufficiency and antibiotic-associated colitis.

The systemic absorption of orally administered vancomycin was evaluated in five patients (six occasions) with moderate to severe renal insufficiency and documented antibiotic-associated colitis. The patients' ages ranged from 28 to 63 years and weights varied from 50.0 to 76.2 kg. Vancomycin doses were 125 mg (one case), 250 mg (three cases), and 500 mg (two cases) every six hours. Multiple serum concentrations were obtained (range four to 19) during the seven- to 28-day courses of vancomycin therapy. Vancomycin serum concentrations were detectable in five of the six cases as soon as two hours after the first dose, and plateaued within four days. A linear relationship between daily dose and the vancomycin serum concentration was observed (r = .8575, P less than .01). Routine monitoring of vancomycin serum concentrations in adult patients may not be necessary unless high dose (greater than 2 g/d) or prolonged therapy (greater than ten days) is required.

Administration, Oral↗

PubMed1998

Burn wound excision and massive blood transfusion did not affect perioperative vancomycin levels.

INTRODUCTION: The effect of burns surgery that requires intraoperative transfusion of five or more units of blood on serum vancomycin levels was assessed. METHODS: Serum vancomycin levels were measured 10 min and 6 h after vancomycin administration with surgery being performed in the interval. The following day the same dose of vancomycin was given and serum vancomycin levels measured at the same times without intervening surgery. RESULTS: Thirteen operations involving nine patients who required a mean blood transfusion of 9.2 units were studied. There was very little difference between 10-min levels, 6-h levels and the change over interval (absolute and percentage) on the day of surgery and the following day. The recorded serum levels were often at the lower end of the desired range, especially in patients who underwent the larger operations. This was the case on both day of surgery and the control day. CONCLUSIONS: Large volume blood loss and replacement during burns surgery did not significantly affect perioperative vancomycin levels. 1998 Elsevier Science Ltd for ISBI.

Adolescent↗

PubMed2002

Impact of deep freezing on the stability of 25 mg/ml vancomycin ophthalmic solutions.

For the treatment of certain eye infections, ophthalmic solutions 'laced' with 25 mg/ml vancomycin are sometimes prepared. Their physical and chemical stability and the maintenance of their sterility were studied after deep freezing at -20 +/- 2 degrees C and thawing, followed or not by refrigeration for 48 h at 4 +/- 2 degrees C. Physical and chemical analysis comprised visual inspection turbidity, determination of pH and osmolality, and assay of vancomycin by high performance liquid chromatography with ultraviolet detection. For microbiological analysis a 25 mg/ml vancomycin ophthalmic solution was filtered through two membranes and cultured on trypticase-soy and Sabouraud-glucose solid media. Any colonies were then counted. These physical, chemical and microbiological analyses demonstrated the stability of 25 mg/ml vancomycin ophthalmic solutions in 5% glucose deep frozen at -20 +/- 2 degrees C for 3 months. The vancomycin concentration varied by no more than 5% of the initial concentration, and no breakdown product was evidenced. Neither pH (mean=3.8 +/- 0.1) nor osmolality (mean=318.3 +/- 5.6 mOsm/kg) varied significantly, and remained compatible with intraocular administration. No particle or bacterial combination was found in the course of the study. The thawing procedure (at ambient temperature or under warm running water from a tap) did not modify the stability of the eye drops. Likewise, storage in a refrigerator for 48 h after thawing did not modify stability. The advantage of storing vancomycin 25 mg/ml ophthalmic solutions for 3 months in deep freeze is that a stock of chemically and microbiologically controlled preparations can be held ready for administration to patients, thereby allowing prompter dispensing, as the eye drops are not made up extemporaneously, while the improved control over production ensures that patients receive solutions of constant quality, as every batch prepared is systematically inspected.

Anti-Bacterial Agents↗

PubMed1998

Quantitation of vancomycin and its crystalline degradation product (CDP-1) in human serum by high performance liquid chromatography.

The delayed clearance of vancomycin results in accumulation of vancomycin crystalline degradation product, CDP-1, in the bodies of renally impaired patients. The 2 isomers, CDP-1-M (major) and CDP-1-m (minor), of CDP-1 are antibiotically inactive but cross-react with some immunoassays that use polyclonal antibodies resulting in falsely elevated results. A high performance liquid chromatographic (HPLC) method was developed to quantitate vancomycin and CDP-1 in the serum of renal patients. After solid phase extraction of 200 microliters serum, the separation of vancomycin, the 2 isomers of CDP-1 and the internal standard (cefazolin) was accomplished by gradient HPLC on a reversed phase C18 column with detection at 210 nm. Linearity was established from 1 to 25 and 25 to 100 micrograms ml-1 vancomycin and 1 to 25 micrograms ml-1 CDP-1. Coefficients of variation for vancomycin and CDP-1 were 3.3-8.6% (n = 10) and 2.8-5.2% (n = 8).

Cefazolin↗

PubMed1999

Vancomycin-resistant enterococci (VRE) colonization of high-risk patients in tertiary care Canadian hospitals. Canadian VRE Surveillance Group.

We isolated 1487 Enterococcus species from 1200 stool specimens collected from high-risk patients in 12 Canadian tertiary care hospitals between October 1995 and November 1996. The composition of the 1487 isolates was 601 vancomycin-sensitive Enterococcus faecalis (40.4%), 667 vancomycin-sensitive Enterococcus faecium (44.9%), 18 vancomycin-resistant (nine isolates MIC 8-16 micrograms/mL; nine isolates MIC > or = 32 micrograms/mL) E. faecium (VREF) (1.2%), 95 vancomycin-sensitive Enterococcus gallinarum (6.4%), 29 vancomycin-resistant (all MICs 8-16 micrograms/mL) E. gallinarum (2.0%), and 77 vancomycin-sensitive Enterococcus casseliflavus (5.2%). Nine of the 18 VREF isolates collected possessed the vanA genotype and were from three patients at one hospital. Two other VREF isolates, of the vanB genotype, were from a single patient at a second hospital, and the remaining seven isolates, also all of the vanB genotype, were from five patients at a third hospital. All VREF were ampicillin resistant (MIC > or = 16 micrograms/mL), streptomycin resistant (MIC > 1000 micrograms/mL), and ciprofloxacin resistant (MIC > or = 4 micrograms/mL). Ten of the 18 VREF were also resistant to gentamicin (MIC > 500 micrograms/mL), while all 18 isolates had quinupristin/dalfopristin MICs < or = 0.5 microgram/mL. In conclusion, high-risk patients in tertiary care Canadian hospitals are rarely colonized (9/1200 patients, 0.75%) with VREF in their lower gastrointestinal tract. These findings correlate well with the lack of reported VREF infection in high-risk patients in Canadian hospitals. Quinupristin/dalfopristin demonstrated excellent in vitro activity against VREF and other non-faecalis species of Enterococcus, many of which also possessed high-level ampicillin, and/or high-level aminoglycoside, and/or ciprofloxacin resistance.

Canada↗

PubMed2000

Comparative pharmacoeconomic study of vancomycin and teicoplanin in intensive care patients.

Randomized clinical trials and meta-analyses have not demonstrated any statistically significant differences between teicoplanin and vancomycin with regard to efficacy. A cost-minimization analysis was conducted to compare the economical impact of the treatment with vancomycin and teicoplanin in intensive care patients. Information on resource utilization was retrospectively collected from 100 consecutive clinical histories of patients hospitalized in a Spanish Intensive Care Unit, who had been given a glycopeptide antibiotic (50 teicoplanin and 50 vancomycin) for the treatment of a suspected or proven infection. Although personnel, material, and monitoring costs were higher in the vancomycin group, the acquisition costs and the total costs were much lower in this group, so the resulting total costs per day were 5508 ptas (33 euros) for vancomycin-treated patients and 9893 ptas (59.5 euros) for teicoplanin-treated patients. The savings with vancomycin for a 10-day course of treatment would be approximately 40697 ptas (244.5 euros) per patient. Results were consistent for a variety of conditions that were included in the sensitivity analysis.

Adolescent↗

PubMed1998

Clinical relevance of a European collaborative study on comparative susceptibility of gram-positive clinical isolates to teicoplanin and vancomycin.

Seventy laboratories in nine European countries (Belgium, France, Germany, Italy, The Netherlands, Portugal, Spain, Switzerland and the UK) each collected 100 consecutive gram-positive bacterial pathogens during 1995. MICs were determined by a co-ordinating laboratory in each country using an agar incorporation method with Mueller Hinton medium (NCCLS). Quality control was ensured by distribution of five test strains to the co-ordinating laboratories. A total of 7078 isolates was collected: 2885 Staphylococcus aureus, 1706 enterococci, 1480 coagulase-negative staphylococci (CNS), 932 Streptococcus spp. (including 289 strains of S. pneumoniae) and 75 miscellaneous species. Of these, the country coordinators successfully re-tested 6824 isolates. Using NCCLS interpretive criteria, overall 39 isolates (including 28 strains of enterococci) were teicoplanin-resistant (0.57%) and 38 (mostly CNS; 0.56%) were intermediate, whilst 32 isolates (including 30 strains of enterococci) were resistant to vancomycin (0.47%) and 7 (all enterococci; 0.10%) were intermediate. The overall resistance rate was < or = 0.5%. The two glycopeptides were essentially active against the major pathogens encountered in the survey. The only real difference with clinical implications from previously reported susceptibility data is the emergence and spread of resistance in enterococci, particularly in E. faecium. Resistance was highest in SSTI, UTI, bloodstream and GI infections; no resistance was encountered in RTI, gynaecological infections or central nervous system infections. This resistance was also geographically diverse: Resistance to vancomycin in E. faecalis was present only in France, Germany, Italy, Portugal and Spain (Italy and Spain only for teicoplanin), whilst resistance to teicoplanin and vancomycin in E. faecium was present in all countries except Spain. Eight isolates (0.5% of all enterococci) were vancomycin-resistant but teicoplanin-susceptible, exhibiting the vanB phenotype. These were four strains of E. faecalis and four strains of E. faecium. Whilst isolates of S. haemolyticus had higher MIC of teicoplanin than other CNS, and were more susceptible to vancomycin, overall resistance to teicoplanin was low (3.3% in S. haemolyticus; 0.6% in CNS). S. haemolyticus was a relatively rare pathogen, accounting for 6.3% of all CNS isolates, and 1.4% of all gram-positives collected. The results of this survey show that, despite occasional nosocomial problems (e.g. with enterococci and S. haemolyticus), teicoplanin or vancomycin remain adequate therapy for infections caused by gram-positive pathogens in the 1990s.

Anti-Bacterial Agents↗

PubMed1999

Binding of glycopeptide antibiotics to a model of a vancomycin-resistant bacterium.

BACKGROUND: The vancomycin group of glycopeptide antibiotics is active against a wide range of gram-positive bacteria. The increasing resistance to vancomycin is the result of a change of an amide linkage (D-Ala-D-Ala) to an ester linkage (D-Ala-D-Lactate) in the bacterial cell-wall precursors. RESULTS: We have used a peptide terminating in the sequence -Lys-D-Ala-D-Lactate linked by its amino terminus to a docosanoyl (C22) acyl chain and anchored in a supported lipid monolayer to mimic the surface of vancomycin-resistant enterococci. Surface plasmon resonance analysis was then used to investigate the binding of glycopeptide group antibiotics to this surface. Vancomycin, which dimerises weakly, bound with low affinity, whereas strongly dimerising antibiotics, such as chloroeremomycin, bound with higher affinities. Antibiotics that have attached hydrophobic groups, such as teicoplanin and biphenylchloroeremomycin (LY307599), bound to the lipid monolayer. This resulted in an enhanced affinity for the lipid-anchored peptide at the surface relative to affinities for an analogous non-anchored peptide in solution. CONCLUSIONS: We have shown that the affinities of glycopeptide antibiotics for a model of the surface of a vancomycin-resistant bacterium are enhanced relative to affinities determined in free solution. We have also shown that antibiotics that have membrane anchors bind tightly to the model surface and that this feature is an important determinant of the ability of an antibiotic to kill vancomycin-resistant enterococci.

Anti-Bacterial Agents↗

PubMed2003

Multivalent drug design. Synthesis and in vitro analysis of an array of vancomycin dimers.

The design, synthesis, and in vitro microbiological analysis of an array of forty covalently linked vancomycin dimers are reported. This work was undertaken to systematically probe the impact of linkage orientation and linker length on biological activity against susceptible and drug-resistant Gram-positive pathogens. To prepare the array, monomeric vancomycin synthons were linked through four distinct positions of the glycopeptide (C-terminus (C), N-terminus (N), vancosamine residue (V), and resorcinol ring (R)) in 10 unique pairwise combinations. Amphiphilic, peptide-based linkers of four different lengths (11, 19, 27, and 43 total atoms) were employed. Both linkage orientation and linker length were found to affect in vitro antibacterial potency. The V-V series displayed the greatest potency against vancomycin-susceptible organisms and vancomycin-resistant Enterococcus faecalis (VRE) of VanB phenotype, while the C-C, C-V, and V-R series displayed the most promising broad-spectrum activity that included VRE of VanA phenotype. Dimers bearing the shortest linkers were in all cases preferred for activity against VRE. The effects of linkage orientation and linker length on in vitro potency were not uniform; for example, (1) no single compound displayed activity that was superior against all test organisms to that of vancomycin or the other dimers, (2) linker length effects varied with test organism, and (3) whereas one-half of the dimers were more potent than vancomycin against methicillin-susceptible Staphylococcus aureus (MSSA), only one dimer was more potent against methicillin-resistant S. aureus (MRSA) and glycopeptide-intermediate susceptible S. aureus (GISA). In interpreting the results, we have considered the potential roles of multivalency and of other phenomena.

Anti-Bacterial Agents↗

PubMed1998

Vancomycin: conformational consequences of the sugar substituent.

High-resolution, three-dimensional structures of vancomycin and aglyco-vancomycin in DMSO were determined by nuclear magnetic resonance, metric matrix distance geometry, and molecular dynamics calculations. Conformational flexibility fast on the NMR time scale was examined by ensemble-based calculations which apply the experimentally derived restraints as an ensemble average. Two families of conformations of vancomycin, differing in the positioning of the vancosamine substituent, were observed. In contrast, the aglyco-vancomycin adopts only one conformation in solution. The conformations of vancomycin and the aglyco-vancomycin differ in the alignment of the amide protons which participate in the hydrogen-bonding network with the cell-wall precursor and orientation of the aromatic rings relative to the backbone. Therefore, the high-resolution structural characterization provides insight into a possible role of glycosylation on the activity of this important family of antibiotics.

Anti-Bacterial Agents↗

PubMed1998

Toxicity of vancomycin on corneal endothelium in rabbits.

PURPOSE: To evaluate the toxic effect of vancomycin on the corneal endothelium related to concentrations of vancomycin. METHODS: The toxic effect is assessed with a weighing method that gives a measure of endothelial function. Thirty-three rabbit corneas were divided into four groups. Three groups of seven corneas each were exposed to concentrations of 1.0 mg/ml, 3.0 mg/ml and 5.0 mg/ml vancomycin, respectively. The fourth group of twelve corneas served as a control group. RESULTS: The corneas exposed to 1.0 mg/ml vancomycin showed no significant weight increase, while the corneas exposed to 3.0 mg/ml and 5.0 mg/ml showed a significant weight increase as compared to the control corneas. The weight increase was significantly larger in the group of corneas exposed to 5.0 mg/ml as compared to 3.0 mg/ml. CONCLUSIONS: In the interval of tested concentrations there is a dose response relationship between vancomycin concentrations and endothelial toxicity. This experiment shows that vancomycin in the concentration of 1.0 mg/ml is non-toxic to the endothelium, while 3.0 mg/ml and 5.0 mg/ml increasingly impair endothelial function.

Animals↗

PubMed1999

Emergence of vancomycin tolerance in Streptococcus pneumoniae.

Streptococcus pneumoniae, the pneumococcus, is the most common cause of sepsis and meningitis. Multiple-antibiotic-resistant strains are widespread, and vancomycin is the antibiotic of last resort. Emergence of vancomycin resistance in this community-acquired bacterium would be catastrophic. Antibiotic tolerance, the ability of bacteria to survive but not grow in the presence of antibiotics, is a precursor phenotype to resistance. Here we show that loss of function of the VncS histidine kinase of a two-component sensor-regulator system in S. pneumoniae produced tolerance to vancomycin and other classes of antibiotic. Bacterial two-component systems monitor environmental parameters through a sensor histidine-kinase/phosphatase, which phosphorylates/dephosphorylates a response regulator that in turn mediates changes in gene expression. These results indicate that signal transduction is critical for the bactericidal activity of antibiotics. Experimental meningitis caused by the vncS mutant failed to respond to vancomycin. Clinical isolates tolerant to vancomycin were identified and DNA sequencing revealed nucleotide alterations in vncS. We conclude that broad antibiotic tolerance of S. pneumoniae has emerged in the community by a molecular mechanism that eliminates sensitivity to the current cornerstone of therapy, vancomycin.

Animals↗

PubMed1984

Vancomycin disposition: the importance of age.

We examined the influence of age on vancomycin kinetics in 12 normal healthy men (six young and six elderly) after an intravenous infusion of 6 mg/kg. Serial blood and urine samples were collected for up to 2 days after dosing and were assayed for unchanged drug by a specific radioimmunoassay. Serum concentrations of vancomycin after infusion declined in a multiphasic manner. Both serum and urinary excretion data were simultaneously fit by a three-compartment model with SAAM-27 computer programs. Estimates of mean t1/2 obtained from the terminal phase of the drug disposition profile showed the t1/2 to be longer in the elderly than in the young subjects (12.1 and 7.2 hr). Although there was no change in the initial distribution volume of the central compartment, total systemic and renal clearances were reduced in the elderly and did not correlate with renal function. The increase in the vancomycin volume of distribution at steady state was ascribed to enhanced tissue binding of drug in the elderly, since the mean fraction of vancomycin bound in systemic pool of the young and elderly did not differ (0.53 and 0.56). In-depth analysis of excretion data tends to support suggestions of vancomycin excretion solely by glomerular filtration. Our data strongly suggest the need for adjustment or modification of recommended vancomycin dosing schedules in the elderly.

Adult↗

PubMed1996

Use of vancomycin in high-flux hemodialysis: experience with 130 courses of therapy.

Vancomycin is often administered to hemodialysis patients at long dosage intervals because its removal by hemodialysis is considered to be negligible. We and others, however, have demonstrated significant removal of vancomycin by high-flux hemodialysis. This report describes our experience with 89 courses of vancomycin using a revised regimen with a loading dose followed by 500 mg doses after each dialysis treatment, and compares results with 41 courses using single weekly dosing. All patients were dialyzed with high-flux membranes using volumetric ultrafiltration and bicarbonate dialysate. Serum vancomycin levels were obtained two hours after completion of infusion (peak) and immediately prior to dialysis (trough) and were measured by Abbot TDx fluorescence polarization immunoassay. Duration of multiple-dose therapy was 11 +/- 8 days, with mean total dose 3.6 +/- 1.8 g. Initial doses of 20 mg/kg rapidly and reliably established therapeutic pre-dialysis serum levels (10 to 25 micrograms/ml). In patients treated with multiple dosing 431 pre-dialysis levels were obtained. The mean level was 15.9 +/- 5.7 micrograms/ml; 55 levels (13%) were less than 10 micrograms/ml and 22 (5%) were above 25 micrograms/ml. In patients treated once weekly, 77% of levels were below 10 micrograms/ml by five days after administration, and 84% at one week. No patient developed demonstrable ototoxicity. Twenty-five patients were treated for > or = two weeks, five for > or = four weeks, and two for > five weeks, with no evidence of toxic accumulation. Mean peak level was 20.1 +/- 4.6 micrograms/ml, with a mean difference from preceding pre-dialysis level of 7.2 +/- 2.2 micrograms/ml. We conclude that in high-flux hemodialysis, a 20 mg/kg loading dose of vancomycin followed by 500 mg doses after each dialysis treatment achieves predictable, adequate and safe therapeutic levels, does not lead to unacceptably high peaks, and does not accumulate during long treatment courses. By contrast, once-weekly vancomycin dosing resulted in subtherapeutic serum levels after five to seven days, and should be abandoned in the high-flux setting.

Aged↗

PubMed1997

Suppression of progenitor cell growth by vancomycin following autologous stem cell transplantation.

The occurrence of hematologic side-effects resulting from the use of vancomycin is rare. Prior to this report, vancomycin-induced neutropenia was believed to be due to a hypersensitivity reaction since antibodies directed against circulating neutrophils have been discovered in the serum of some patients. We demonstrate suppression of hematopoietic bone marrow progenitor cells in a patient experiencing vancomycin-induced neutropenia after an autologous hematopoietic stem cell transplantation for multiple myeloma. A bone marrow (BM) specimen obtained at the time of neutropenia demonstrated direct suppression of progenitor cell growth in vitro when vancomycin was added at increasing concentrations (1, 10 and 50 microg/ml). No such trend was noted in a BM sample from the same patient obtained 11 months prior to transplantation and a normal control BM. The decrease in the total number of colony-forming units (CFU) was statistically significant at all the dose levels of vancomycin when compared to the number of CFU in the baseline BM sample (P < 0.05). The myeloid maturation arrest observed in the bone marrow sample obtained during the period of neutropenia and the dose dependent growth inhibition by vancomycin observed in vitro suggest a novel nonimmune mechanism of hematologic effects due to suppression of bone marrow progenitor cell growth.

Anti-Bacterial Agents↗

PubMed1971

Physicochemical properties of vancomycin and iodovancomycin and their complexes with diacetyl-L-lysyl-D-alanyl-D-alanine.

Electrometric and spectrophotometric titrations showed vancomycin to contain groups having pK values of about 2.9, 7.2, 8.6, 9.6, 10.5 and 11.7. Of these the four last-named were phenolic. Titration above pH11 and below pH1 was irreversible and antibiotic potency was destroyed. Combination with the specific peptide diacetyl-l-lysyl-d-alanyl-d-alanine hindered the titration of the first three phenolic groups. Spectrophotometric titration of iodovancomycin showed that the phenolic group with pK 9.6 was the one iodinated. The stability of the vancomycin-peptide complex in the range pH1-13 showed that complex-formation occurred only when carboxyl groups were ionized and the phenolic groups were non-ionized. The complex was formed in concentrations of urea up to 8m, of potassium chloride up to 4m, of sodium dodecyl sulphate up to 1%, and at temperatures up to 60 degrees C. From titration curves, organic chlorine and iodine analysis, and combination with peptide, a minimum molecular weight for vancomycin of 1700-1800 was estimated. Optical-rotatory-dispersion and circular-dichroism experiments suggested that vancomycin has only limited conformational flexibility. Both vancomycin and its complexes with peptide exhibited properties suggesting aggregation. Vancomycin and iodovancomycin can be fractionated into a main fraction and at least three minor components. The isolation of these fractions salt-free is described and their antibiotic properties are shown to correlate with their ability to form complexes with peptide.

Alanine↗

PubMed1998

Constant rate infusion of vancomycin in premature neonates: a new dosage schedule.

AIMS: Since vancomycin's bactericidal action has been shown to be time-dependent, a constant rate infusion over 24 h might result in a better bactericidal efficacy. The purpose of this study was to define a new dosage schedule in prematures. METHODS: Two vancomycin 24 h constant rate infusion schedules were tested in two groups of neonates. Postconceptional age (PCA) was 27 to 41 weeks in group 1 (n=24) and 28 to 51.5 weeks in group 2 (n=29). Group 1 neonates received continuous infusion of 10 to 30 mgkg(-1) day(-1), adjusted for PCA and weight. Group 2 was designed to take into account the significant relationship observed in group 1 between vancomycin clearance standardized on weight and PCA and consisted of a constant loading dose of 7 mg kg(-1) followed by continuous infusion of 10 to 40 mg kg(-1) day(-1) adjusted for PCA and weight. RESULTS: Mean vancomycin serum concentration at steady state was 11+/-3.1 mg1(-1) in group 1 and 15.4+/-6.2 mg1(-1) in group 2. Fifty-six percent of group 1 values vs 88% of group 2 values were between 10 and 30 mg at steady state (P<0.01). Both regimens were well tolerated. CONCLUSIONS: A loading dose of vancomycin followed by constant rate infusion of the appropriate dose adjusted for PCA and weight might improve vancomycin concentrations in neonates.

Anti-Bacterial Agents↗

PubMed2002

Decolonization of methicillin-resistant Staphylococcus aureus using oral vancomycin and topical mupirocin.

The objective of this study was to assess the efficacy and safety of a short course of oral vancomycin and intranasal mupirocin ointment in the eradication of methicillin-resistant Staphylococcus aureus (MRSA) colonization. During an outbreak of MRSA, the colonized subjects received oral vancomycin and topical mupirocin. They were screened for MRSA 1, 3, 6 and 12 months after decolonization. A questionnaire was developed to evaluate the side-effects of oral vancomycin. Thirty-five subjects were treated. Clearance was achieved in all cases, in 24 (69%) subjects after one course of therapy. Twenty-eight (80%) subjects experienced some side-effects, including six (17%) who did not tolerate oral vancomycin. Although oral vancomycin, in combination with topical mupirocin, is effective in the elimination of MRSA colonization, there is a need for further studies to confirm our results and to evaluate the safety of oral vancomycin.

Administration, Oral↗