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15 June 2007

Volume 44, Number 12
Clinical Infectious Diseases 2007;44:1536–1542
© 2007 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4412-0003$15.00
DOI: 10.1086/518451
IDSA LECTURE

Point: Vancomycin Is Not Obsolete for the Treatment of Infection Caused by Methicillin‐Resistant Staphylococcus aureus

John F. Mohr1 and

Barbara E. Murray1,2

1Department of Internal Medicine, Division of Infectious Diseases and Center for Emerging and Re‐emerging Pathogens, and 2Department of Microbiology and Molecular Genetics, University of Texas Health Science Center at Houston

Since the discovery, development, and US Food and Drug Administration approval of vancomycin in the 1950s, this agent has remained a mainstay for the treatment of infections caused by methicillin‐resistant Staphylococcus aureus (MRSA). However, because of the development of new antistaphylococcal antibiotics and reports of vancomycin failures, the utility of vancomycin has recently been questioned. Although vancomycin did not undergo the strict US Food and Drug Administration approval process that is in place today to demonstrate efficacy, there is considerable information available that sheds light on the role vancomycin has in infectious diseases pharmacotherapy today. In addition, although we look to in vitro susceptibility testing to assess vancomycin activity against S. aureus, we have come to appreciate that resistance of S. aureus to vancomycin can be a continuous—rather than a categorical—phenomenon. This has resulted in clinical microbiology laboratories having difficulty identifying S. aureus that may not respond to conventional doses of vancomycin. A better understanding is needed of the pharmacodynamic relationship between vancomycin and MRSA as relates to optimal dosing strategies, including consideration for loading doses, and development of rational categorical breakpoints for susceptibility based on clinical outcomes. By better understanding these critical issues, it may be possible to optimize the use of vancomycin, resulting in a cost‐effective treatment option for many patients infected with MRSA.

Received 21 March 2007; accepted 21 March 2007; electronically published 4 May 2007.

  • (See the counterpoint by Deresinski on pages 1543–8)

Reprints or correspondence: Dr. Barbara E. Murray, Div. of Infectious Diseases, University of Texas Health Science, Center at Houston, 6431 Fannin, MSB 2.112, Houston, TX 77030 ().

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  • This is a modified version of a paper presented at the 44th Annual Meeting of the Infectious Diseases Society of America, Toronto, Ontario, Canada, 12–15 October 2006.

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