Provider Briefing: The Vancomycin Shortage in 2026

The Vancomycin supply disruption — primarily affecting the intravenous formulation — continues to impact clinical practice across the United States in 2026. For providers managing patients with serious gram-positive infections, MRSA bacteremia, endocarditis, or Clostridioides difficile infections, the shortage has created prescribing challenges that require awareness, flexibility, and proactive planning.

This article provides an updated overview of the shortage, its clinical implications, alternative strategies, and resources to help your patients access the medication they need.

Shortage Timeline

Vancomycin injection has experienced intermittent supply disruptions since 2016. The current shortage cycle began in earnest in 2023-2024 and has persisted into 2026:

• 2016-2017: Initial sporadic shortages reported due to manufacturing quality issues
• 2018: Significant shortage affecting multiple health systems; FDA involvement in monitoring supply
• 2019-2022: Relative stability with occasional supply constraints
• 2023-2024: Renewed shortage driven by manufacturing disruptions at several key facilities, compounded by increased demand from rising MRSA prevalence
• 2025-2026: Ongoing shortage. ASHP lists Vancomycin Hydrochloride Injection as currently in shortage. Fresenius Kabi has limited availability with short-dated 5 g vials (expiring before June 2026). Pfizer/Hospira, Hikma, and Xellia continue to report intermittent supply constraints

Prescribing Implications

The shortage has several practical implications for prescribers:

Formulary and Protocol Adjustments

Many health systems have implemented Vancomycin conservation protocols, including:

• Restricting empiric Vancomycin use to cases with high MRSA probability
• Implementing automatic stop orders and requiring infectious disease consultation for extended courses
• Prioritizing Vancomycin IV for indications where alternatives are limited (e.g., MRSA endocarditis, meningitis)
• Utilizing therapeutic drug monitoring (TDM) with AUC-guided dosing to optimize therapy duration and reduce waste

Oral Vancomycin Considerations

Oral formulations (capsules and Firvanq solution) have been less affected by the shortage but are not immune to supply disruptions. Key considerations:

• Generic Vancomycin capsules (125 mg) are available from multiple manufacturers
• Compounding oral Vancomycin solution from IV powder remains a viable option when capsules are unavailable
• For C. difficile infections, consider Fidaxomicin (Dificid) as a first-line alternative — IDSA/SHEA guidelines already position it as preferred therapy for initial and recurrent episodes

Alternative Agents

When Vancomycin IV is unavailable, the choice of alternative depends on the infection site and organism:

• Daptomycin (Cubicin): Preferred for MRSA bacteremia and right-sided endocarditis. Not appropriate for pneumonia (inactivated by surfactant). Dose: 6-10 mg/kg IV once daily depending on indication
• Linezolid (Zyvox): Effective for MRSA pneumonia, skin/soft tissue infections, and osteomyelitis. Available in oral and IV forms. Monitor for thrombocytopenia with courses exceeding 14 days. Serotonin syndrome risk with concomitant serotonergic agents
• Telavancin (Vibativ): Lipoglycopeptide option for hospital-acquired pneumonia and complicated skin infections. Monitor renal function closely
• Trimethoprim-Sulfamethoxazole (TMP-SMX): Oral option for uncomplicated MRSA skin infections; not appropriate for bacteremia or endocarditis

For more on these alternatives, see our clinical overview of Vancomycin alternatives.

Current Availability Picture

As of February 2026:

• IV Vancomycin: Active shortage per ASHP. Hospital supply chains generally have better access than outpatient settings. Allocation policies are in effect at most distributors
• Oral capsules (generic): Available at most retail pharmacies, though stock may be inconsistent. Cash price ranges from $39-$120 with coupon to over $4,400 without discount
• Oral solution (Firvanq): Available by prescription from Azurity Pharmaceuticals. Cash price approximately $122-$593 for 150 mL

Cost and Access Challenges

Beyond availability, cost remains a significant barrier for patients receiving oral Vancomycin:

• Brand-name Vancocin capsules carry a cash price of up to $4,469 for 40 capsules
• Generic capsules with discount coupons (GoodRx, SingleCare) reduce this to $39-$120
• Insurance coverage is generally good, but some plans require prior authorization for oral Vancomycin
• Medicare Part D covers oral Vancomycin; Part B covers IV administration in clinical settings

Encourage patients to use discount programs and explore patient assistance options. See the patient-facing guide on saving money on Vancomycin, or the provider guide on helping patients save on Vancomycin.

Tools and Resources for Providers

Several resources can help you and your patients navigate the shortage:

• Medfinder for Providers: Real-time pharmacy availability search. Direct patients here or use it yourself to locate stock near your practice
• ASHP Drug Shortage Resource Center: Updated shortage details, expected resolution dates, and clinical management recommendations
• FDA Drug Shortage Database: Official manufacturer supply status reports
• Institutional Pharmacy Partnerships: Hospital pharmacies may have access to Vancomycin through institutional supply chains when retail channels are depleted

Looking Ahead

There is no confirmed resolution date for the Vancomycin injection shortage. Manufacturers have increased production capacity, but the combination of ongoing demand growth and complex fermentation-based manufacturing means supply recovery will be gradual.

Providers should:

• Maintain familiarity with alternative agents and their indications
• Implement stewardship protocols to conserve Vancomycin for highest-priority uses
• Proactively communicate with patients about potential supply issues and cost-saving strategies
• Monitor ASHP and FDA shortage databases for updates

Final Thoughts

The Vancomycin shortage requires a multifaceted response from prescribers: clinical flexibility in choosing alternatives, institutional protocols to optimize use, and patient-facing support to address access and affordability barriers. Tools like Medfinder for Providers can streamline the process of locating available supply for your patients.

For detailed step-by-step guidance on helping patients find Vancomycin, see our companion post: How to help your patients find Vancomycin in stock: a provider's guide.