Vancomycin in Perspective

In this issue of the AJDC , Odio et al 1 and Alpert et al 2 report disturbing observations concerning the clinical use of vancomycin hydrochloride. The pharmaceutical formulation of vancomycin has been vastly improved in recent years, and the more uniform preparation has been considered reasonably safe when administered and monitored appropriately. However, concerns about the safety of vancomycin raised in this issue of theJournalargue for an analysis of its usefulness and limitations. HISTORY Vancomycin was first isolated in 1956 in the Eli Lilly & Co, laboratories, Indianapolis, from strains of Streptomyces orientalis . It began to be used clinically in the late 1950s, particularly for serious infections caused by staphylococci, in which penicillin and other antimicrobial agents were often ineffective. The original pharmaceutical preparation was extremely irritating to veins—a vexation for patients, as well as clinicians and nurses. Some clinicians, not very affectionately, called the preparation Mississippi mud