Antimicrobial

Vancomycin

The reference glycopeptide antibiotic for serious MRSA infections, and an oral treatment for C. difficile.

Strong evidenceApproved drugAdd to compare

What it is

Vancomycin is a glycopeptide antibiotic first isolated from a soil bacterium in the 1950s. It is a branched peptide structure that binds the building blocks of the bacterial cell wall. Given intravenously it treats serious Gram-positive infections including MRSA; given by mouth it is not absorbed and acts inside the gut, which is how it treats Clostridioides difficile colitis.

How it works

1
Binds the D-Ala-D-Ala terminus of cell-wall precursors, blocking the transglycosylation and cross-linking steps.
2
Prevents peptidoglycan assembly, so the bacterium cannot build a stable wall.
3
Bactericidal against dividing Gram-positive organisms.
4
The oral route is not absorbed, so the drug stays in the gut lumen.
5
Gram-negative bacteria are intrinsically resistant because of their outer membrane.

What it's studied for

MRSA bacteraemia and complicated skin infection

Clostridioides difficile infection (oral)

Endocarditis and bone and joint infection caused by Gram-positive organisms

Surgical prophylaxis in hospitals with high MRSA rates

Meningitis with Gram-positive cover (intravenous, sometimes intraventricular)

Reported and studied effects

Clinical cure rates of roughly 70 to 85% in MRSA bacteraemia trials
Bacteriological clearance in C. difficile with oral therapy
Nephrotoxicity risk that rises with higher exposure and concurrent kidney-toxic drugs
Infusion-related flushing known as red man syndrome

Research protocol notes

Research context only

Research context only - a hospital antibiotic. Standard intravenous dosing is 15 to 20 mg per kilogram every 8 to 12 hours with the interval adjusted to kidney function, monitored through an AUC/MIC target of about 400 to 600 or trough levels; oral C. difficile dosing is typically 125 mg four times daily for 10 days. Trials follow clinical and microbiological cure at test-of-cure visits.

These figures are described so you can understand what researchers did. They are not a dose, a schedule, or a suggestion — and they are not a substitute for a doctor.

Possible side effects and contraindications

Safety profile

Possible side effects

Nephrotoxicity, especially with other kidney-toxic drugs
Red man syndrome from rapid infusion
Ototoxicity with high exposure
Neutropenia with prolonged use
Phlebitis at the infusion site
Rare thrombocytopenia

Contraindications and cautions

Prior severe hypersensitivity to vancomycin
Must be dose-adjusted in kidney impairment
Caution with concurrent aminoglycosides or other nephrotoxins
Rapid infusion should be avoided

A side-effect list is never complete, and these are not the only situations that warrant caution. Anything unexpected, or anything you are unsure about, should be discussed with a doctor before use.

Evidence assessment

Strong evidenceReplicated, large human trials

Replicated, large human trials

Randomised trials in MRSA bacteraemia, C. difficile infection and surgical prophylaxis, plus decades of pharmacokinetic and outcome data.

References

References link to published literature, regulator pages or literature indexes. Where a link points to a search, it collects the peer-reviewed work on that molecule rather than a single study.

Compare Vancomycin with another peptide →

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Colistin (polymyxin E)

A last-resort lipopeptide antibiotic kept for multidrug-resistant Gram-negative infections, at the cost of kidney toxicity.

Limited evidenceApproved drug

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Dalbavancin

A long-acting lipoglycopeptide that treats serious skin infections with one or two doses instead of a week of infusions.

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Daptomycin

A lipopeptide antibiotic that disrupts bacterial membranes, approved for MRSA bloodstream and skin infections but not pneumonia.

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