Opportunities of vancomycin yesterday and today

Keywords: vancomycin; adverse reactions; red man syndrome.


Vancomycin is one of the oldest antibiotics that has been used in clinical practice for about 70 years. Currently, vancomycin is mainly prescribed for the treatment of infections caused by methicillin-resistant Staphylococcus (S.) aureus, methicillin-resistant epidermal staphylococcus, and amoxicillin-resistant enterococci, and in oral form for the treatment of diarrhea caused by Clostridium difficile. Vancomycin is effective against most gram-positive cocci and bacilli, with the exception of rare organisms and enterococci that have become resistant to vancomycin, mainly Enterococcus faecium. Previously, vancomycin was associated with many side effects, including vestibular and renal, due to impurities contained in its early formulations. Over the years, the impurities have been removed, and vancomycin now has far fewer vestibular side effects, but can still cause nephrotoxicity at higher doses or when used over a long period. Currently, vancomycin is considered a relatively safe drug, adverse events are manifested due to red man syndrome. Other adverse effects of vancomycin include neutropenia, prostatitis, phlebitis, ototoxicity, thrombocytopenia, interstitial nephritis, lacrimation, linear IgA bullous dermatosis, necrotizing cutaneous vasculitis, and toxic epidermal necrolysis. Vancomycin has been a valuable agent in the treatment of infections for many decades and is still used today as the main glycopeptide antibiotic against methicillin-resistant S. aureus, methicillin-resistant epidermal staphylococcus, and enterococci susceptible to vancomycin. It is likely to remain effective as long as resistance to vancomycin remains controlled until other drugs with higher efficacy and fewer side effects become available. However, despite several decades of use, our knowledge of the side effects of vancomycin still needs to be completed. During its 70-year “life”, the pharmacological analysis of its safety has changed significantly. Therefore, this article summarizes the current information about the side effects of vancomycin, especially measures in case of its overdose, as well as features of supportive therapy.


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Drohovoz, S. M., Babenko, M. M., Shtroblia, A. L., Bilyk, L. S., ShchokinaК. H., Shtroblia, V. V., Ivantsyk, L. B., Krutskikh, T. V., Vashkeba-Bitler, E. M., & Shtroblia, M. V. (2023). Opportunities of vancomycin yesterday and today. Likars’ka Sprava, (1), 5–18. https://doi.org/10.31640/LS-2023-1-01