Health knowledge made personal
Join this community!
› Share page:
Search posts:

One-dose vancomycin for SSTIs: Just don't do it

Posted Jan 23 2013 12:00am

Valid for practice

True to literature

Overall quality

Please peer-review this blog post above by clicking on stars.

You are managing an otherwise healthy patient with cellulitis but no abscess to poke. You decide this patient needs antibiotics but is stable enough to go home.

"Give em' a dose of vanc before they go," right?

Here is why giving one dose of IV vancomycin for SSTIs in stable patients is a bad idea:
  • NO evidence that this shows any benefit.
  • Not recommended by the Infectious Diseases Society of America (IDSA)
  • Extends the patient's ED stay by at least an hour for the IV infusion
  • Increases the cost of the ED visit (IV line, medication, RN time)
  • Pharmacokinetically 1 dose of vancomycin makes no sense for SSTIs
-   1 gm IV x 1 is sub-therapeutic for decent adult kidneys -   Effective bug-killing is based on drug levels achieved with repeated dosing over several days Here is how I subjectively approach consults for uncomplicated SSTI antibiotics:

Some will argue that we should still give SSTI patients one dose of IV antibiotics and send them out on the same PO antibiotics - i.e. clindamycin. Remember that infusion time for IV antibiotics is usually 30-60 minutes, the same time it takes for the antibiotics to be absorbed from the GI tract, so giving 1 dose of IV antibiotics as a "load" before discharge is not necessary. 
Oral antibiotics commonly used for SSTIs and their bioavailability (source - package inserts):
  • Clindamycin ~90%
  • Sulfamethoxazole/Trimethoprim ~100%
  • Doxycycline ~100%
  • Linezolid ~100%
Would love your feedback! @ZEDPharm

Reference Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. Clin. Infect. Dis. 2011;52(3):285–92. Pubmed  21217178

See the real-time results from this Peer Review demographics survey
Post a comment
Write a comment:

Related Searches