Vancomycin Hydrochloride for Injection — CareFirst (Caremark)
Skin and skin structure infections due to methicillin-susceptible staphylococci in penicillin-allergic patients, or those patients who cannot receive or have failed to respond to other drugs, including penicillins or cephalosporins
Initial criteria
- Patient must have infection proven or strongly suspected to be caused by susceptible bacteria
- Use only when indicated for listed infections
- For enterococcal endocarditis, must be used in combination with an aminoglycoside
- For early-onset prosthetic valve endocarditis caused by Staphylococcus epidermidis, must be used in combination with rifampin and an aminoglycoside
- For oral use, restricted to treatment of antibiotic-associated pseudomembranous colitis due to C. difficile and staphylococcal enterocolitis
- Bacterial cultures should be obtained prior to and during treatment to identify etiologic organisms and determine susceptibility to vancomycin