If renal function allows consider synergistic combination with gentamicin 1mg/kg IV q8-12h for 2-4 weeks.

Vancomycin should only be used in setting of ampicillin resistance or severe penicillin allergy.

Desired vancomycin trough is 10-20mg/L. Monitor renal function closely. See Vancomycin Dosing & Monitoring Guidelines.