Vancomycin is indicated for the treatment of serious, life-threatening infections by Gram-positive (aerobic and/or anaerobic) bacteria unresponsive to other antibiotics.
The increasing emergence of vancomycin-resistant enterococci has resulted in the development of guidelines for use by the Centers for Disease Control Hospital Infection Control Practices Advisory Committee. These guidelines restrict use of vancomycin to these indications:
* treatment of serious infections caused by susceptible organisms resistant to penicillins (methicillin-resistant S. aureus (MRSA) and multidrug-resistant S. epidermidis (MRSE)) or in individuals with serious allergy to penicillins,
* treatment of pseudomembranous colitis caused by C. difficile; in particular, in cases of relapse or where the infection is unresponsive to metronidazole treatment (for this indication, vancomycin is given orally, rather than by its typical intravenous route),
* treatment of infections caused by Gram-positive microorganisms in patients with serious allergies to beta-lactam antimicrobials,
* antibacterial prophylaxis for endocarditis following certain procedures in penicillin-hypersensitive individuals at high risk,
* surgical prophylaxis for major procedures involving implantation of prostheses in institutions with a high rate of MRSA or MRSE,
* early in treatment as an empiric antibiotic for possible MRSA infection while waiting for culture identification of the infecting organism,
* halting the progression of primary sclerosing cholangitis and preventing symptoms; vancomycin does not cure the patient and success is limited,
* treatment of endophthalmitis by intravitreal injection for gram-positive bacteria coverage;  it has been used to prevent the condition, however, is not recommended due to the risk of side effects.