Review and prospect of vancomycin

Abstract

Vancomycin the first glycopeptide antibiotic produced by Amycolatopsis orientalis isolated from the soil of Borneo in 1956, and vancomycin was first distributed by Eli Lily in 1958. The early preparations before 1965 were called 'Mississippi mud' because the purity was only 65%, and the impurity caused renal impairment. On the other hand, the purity has improved to greater than 95% since 1995. Vancomycin is active against most Gram-positive pathogens including methicillin-resistant Staphylococcus aureus (MRSA). Vancomycin was used not only to treat MRSA infections but also as empirical therapy for bacteremia due to Gram-positive cocci and for community acquired bacterial meningitis include penicillin-resistant Streptococcus pneumoniae. The clinical practice guidelines for the treatment of MRSA infections published by the Infectious Diseases Society of America (IDSA) recommended in principle vancomycin as the first-line therapy for all MRSA infections including MRSA pneumonia However, an increasing incidence of vancomycin MIC creep and therapeutic failure related to vancomycin MIC greater than 1.5 or 2 mg/L has been reported. Meanwhile, some data showed that the site of infection predicts vancomycin treatment failure rather than the MIC in MRSA bacteremia Achievement of VCM AUC/MIC greater than 400 is related to clinical improvement. Nevertheless, therapeutic drug monitoring (TDM) for intravenous vancomycin is strictly required by hospital pharmacists. Vancomycin should be used in a more rational way because the list of approved anti-MRSA agents is limited in Japan. Cooperation among the pharmaceutical department, microbiological laboratory and clinicians contributes to better clinical outcome and medical safety management in hospital settings. Thus, although vancomycin is one of the 'old' antibiotics, it is absolutely indispensable nowadays.