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

Posted Jan 23 2013 12:00am

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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


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