Vancomycin is often combined with a second antibiotic, most often rifampin or gentamicin, for the treatment of serious methicillin-resistant Staphylococcus aureus infections. Published data from experiments evaluating these and other vancomycin-based combinations, both in vitro and in animal models of infection, often yield inconsistent results, however. More importantly, no data are available from randomized clinical trials to support their use, and some regimens are known to have potential toxicities. Clinicians should carefully reconsider the use of vancomycin-based combination therapies for the treatment of infection due to methicillin-resistant S. Vancomycin is often combined with other antibiotics for the treatment of serious infection due to Staphylococcus aureus , a practice that emerged largely in response to the recognition of important shortcomings of this glycopeptide antibiotic. These shortcomings include poor tissue and intracellular penetration, lack of activity against organisms growing in biofilm, slow bactericidal effect, lack of interference with toxin production, and lack of activity against some S.
Antibiotics - EMCrit Project
Since concentrations in microdialysates and abscesses are not frequently available for humans, this review focuses on drug CSF concentrations. When several equally active compounds are available, a drug which comes close to these physicochemical and pharmacokinetic properties should be preferred. Several anti-infectives e. In many cases, however, pharmacokinetics have to be balanced against in vitro activity.
Evidence from a recent randomized controlled trial suggests that dexamethasone as adjunct therapy in adult pneumococcal meningitis reduces mortality and neurological sequelae. However, adding dexamethasone has the potential to reduce penetration of vancomycin into the cerebrospinal fluid CSF. We sought to determine concentrations of vancomycin in serum and CSF of patients with suspected or proven pneumococcal meningitis receiving dexamethasone to assess the penetration of vancomycin into the CSF during steroid therapy. In an observational open multicenter study, adult patients admitted to the intensive care unit because of suspected pneumococcal meningitis received recommended treatment for pneumococcal meningitis, comprising intravenous cefotaxime mg per kg of body weight per day , vancomycin administered as continuous infusion of 60 mg per kg of body weight per day after a loading dose of 15 mg per kg of body weight , and adjunctive therapy with dexamethasone 10 mg every 6 h.
Antibiotics in the ICU are in some ways simpler than antibiotic therapy for less ill patients. IV access isn't an issue. Patients are critically ill, so we're justified in using broad-spectrum agents initially. There is considerable variation in this between different hospitals, so when in doubt consider your local antibiogram and consult with pharmacists and infectious disease specialists. Antibiograms vary greatly in different geographic locales.