What happens when you stop taking vancomycin?

October 6, 2025 •

4 min read

According to the Infectious Diseases Society of America, approximately 25% of patients treated for a C. difficile infection with vancomycin can experience a recurrence after therapy is stopped. This high rate of relapse highlights the critical importance of understanding what happens when you stop taking vancomycin and why completing the full course is non-negotiable.

Quick Summary

Prematurely discontinuing vancomycin therapy can lead to a more virulent, relapsed infection and contributes to the emergence of antibiotic-resistant bacteria. Completing the entire course as prescribed is crucial for full recovery.

Key Points

Infection Relapse: Stopping vancomycin prematurely allows surviving, resilient bacteria to multiply, causing the infection to return, often more severely.
Antibiotic Resistance: Incomplete treatment fosters the growth of resistant bacteria, making future infections harder to treat with standard antibiotics.
Increased Symptoms: A relapsed infection can lead to a return or worsening of symptoms, requiring a longer and more complex recovery.
Special Concern for C. difficile: Relapse of Clostridioides difficile infection is a notable risk, with up to 25% of patients experiencing recurrence after initial vancomycin therapy.
Adherence is Crucial: Always complete the full course of vancomycin as prescribed, even if you begin to feel better, to ensure full eradication of the infection and minimize long-term risks.
Pharmacological Basis: Vancomycin's elimination process, particularly in patients with renal issues, means that therapeutic levels drop, leaving behind persistent bacteria if treatment is stopped early.

The Critical Consequences of Stopping Vancomycin Early

Vancomycin is a powerful antibiotic used to treat serious bacterial infections, including those caused by methicillin-resistant Staphylococcus aureus (MRSA) and Clostridioides difficile (C. difficile). While a person may begin to feel better within the first few days of treatment, this does not mean the infection is fully eliminated. Finishing the entire prescribed course is essential to eradicate all the harmful bacteria. Stopping too soon, even for a day or two, can have significant and dangerous consequences.

The Major Risks of Premature Cessation

Infection Relapse

One of the most immediate and common risks of stopping vancomycin early is the recurrence of the original infection. The antibiotic works by killing the bacteria responsible for the illness, but the most resilient microorganisms are often the last to be eliminated. When treatment is stopped prematurely, these tough bacteria can survive and multiply, causing the infection to return. For conditions like C. difficile colitis, this risk is particularly pronounced. Studies show that a significant percentage of patients experience a relapse within weeks of stopping vancomycin, with symptoms often coming back as severe or even worse than the initial episode.

The Development of Antibiotic Resistance

Beyond just a relapse, discontinuing vancomycin early fuels the broader public health crisis of antibiotic resistance. The surviving bacteria that endured the initial partial treatment are the strongest, and their continued survival means they are more likely to develop resistance to the antibiotic. These resistant strains are then much harder to treat, potentially requiring more aggressive, expensive, or even ineffective treatments in the future. This not only impacts the patient's own health but also contributes to the proliferation of drug-resistant pathogens in the community.

Worsening Symptoms and Potential Complications

The return of an infection is not a minor inconvenience. Patients may experience a worsening of their original symptoms, including fever, chills, severe diarrhea, and pain. For systemic infections treated with intravenous vancomycin, complications could involve the kidneys, heart, or other organs. A relapsed infection can lead to prolonged illness, re-hospitalization, and a more complex and difficult recovery process.

Comparing Complete vs. Incomplete Treatment

This table illustrates the different outcomes associated with adhering to the full vancomycin prescription versus stopping treatment prematurely.


Feature	Completing the Full Course	Stopping Prematurely
Infection Eradication	High chance of fully eliminating the bacterial infection.	Risk of surviving, resilient bacteria causing a relapse.
Antibiotic Resistance	Minimized risk, as full dose eliminates weaker and stronger bacteria.	Increased risk of fostering antibiotic-resistant strains.
Symptom Resolution	Gradual and sustained improvement leading to full recovery.	Initial improvement followed by a return or worsening of symptoms.
Relapse Risk	Low risk of recurrence once the full course is finished.	High risk of the infection returning, especially with C. difficile.
Future Treatment	Standard treatment protocols are effective if future infections occur.	Future infections, even from different pathogens, could be harder to treat.

Specific Risks for Clostridioides difficile Infection

Patients treated with oral vancomycin for C. difficile infection (CDI) face unique challenges. The risk of recurrence is significant, even after a full course of treatment. To combat this, healthcare providers sometimes prescribe a tapered and pulsed regimen of vancomycin to help gradually restore the gut's normal microbiome while keeping C. difficile suppressed. If a relapse occurs, alternative strategies like fidaxomicin or fecal microbiota transplantation may be necessary. It is crucial to monitor symptoms closely for up to eight weeks after completing a vancomycin course for CDI.

The Role of Pharmacokinetics

Vancomycin's pharmacological profile further explains why completing the course is vital. The drug is primarily eliminated by the kidneys. In patients with impaired renal function, the elimination half-life is significantly longer, requiring dosage adjustments. Regular therapeutic drug monitoring (TDM) is often performed to ensure levels remain therapeutic. When vancomycin is abruptly stopped, the concentration in the body falls, allowing any remaining bacteria to recover and proliferate without a therapeutic check.

Signs of infection returning:

Fever and chills
Watery or bloody diarrhea
Severe stomach cramps
Nausea and vomiting
Persistent abdominal pain
Increased tiredness or weakness
A general feeling of being unwell

Conclusion

Stopping vancomycin before the prescribed course is complete poses serious and predictable risks, including treatment failure, infection relapse, and the development of antibiotic resistance. Adherence to the full prescription, even when symptoms improve, is not merely a suggestion—it is a critical part of a successful recovery and a key strategy in combating antibiotic resistance. For more information, consult the MedlinePlus Drug Information on Vancomycin. If you have stopped taking your medication early or are experiencing a return of symptoms, contact your healthcare provider immediately to discuss your next steps.

How to take Vancomycin correctly

Complete the full course: Take the medication for the entire duration prescribed by your doctor, even if you start to feel better after a few days.
Adhere to the schedule: Take your doses at the same time each day to maintain a consistent level of medication in your system.
Never double up: If you miss a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed one and continue your regular schedule. Do not take extra doses.
Follow specific instructions: For oral vancomycin, shake the liquid well before each use. For intravenous vancomycin, the infusion rate must be carefully controlled.
Talk to your doctor: If you have any questions or are struggling to remember your doses, contact your healthcare provider for assistance.

Frequently Asked Questions

You should not stop taking vancomycin just because you feel better. Feeling better is a sign that the antibiotic is working, but it does not mean all the bacteria are gone. You must complete the full prescribed course to ensure the infection is completely eliminated and to prevent a relapse.

Stopping vancomycin prematurely increases the risk of developing antibiotic resistance. The strongest bacteria, which survive partial treatment, can then multiply and become resistant to the medication, making future infections more difficult to treat.

Yes. The most common risk is a relapse of the original infection because not all the pathogens were destroyed. This is especially true for C. difficile infections, which have a high rate of recurrence.

If you miss a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed one and continue your regular dosing schedule. Never double up on your medication to make up for missed doses.

The risk of C. difficile recurrence is highest within the first 8 weeks after completing vancomycin treatment, although it can occur as long as two or three months later.

A returning infection may present with symptoms such as fever, chills, worsening diarrhea, severe abdominal pain, and general fatigue. If you experience these symptoms after stopping vancomycin, contact your doctor immediately.

When treatment stops early, the concentration of the antibiotic drops. This allows any remaining bacteria, particularly the most resilient ones, to survive and recover, leading to a relapse of the infection.