The use of vancomycin for therapeutic and prophylactic purposes has been in focus for past several years. New and updated research regarding its pharmacokinetic and pharmacodynamic properties, toxicity, resistant strains, and therapeutic drug monitoring (TDM) procedures may change the way vancomycin is being used currently. Vancomycin resistance is a major impediment and has the potential of rendering vancomycin use to obsolescence. Vancomycin resistant enterococcus (VRE) is a highly resistant pathogen which is linked to overuse of vancomycin. In response, Hospital Infection Control Practices Advisory Committee (HICPAC) released guidelines for the proper utilization of vancomycin to restrict and control overuse of vancomycin. Additionally, North American consensus review published guidelines for the proper procedures for vancomycin TDM to ensure the most efficacious vancomycin therapy. The aim of this project was to describe the prescribing pattern and TDM of vancomycin at Sultan Qaboos University Hospital (SQUH) and to compare it with HICPAC, North American consensus review for vancomycin TDM and SQUH antibiotic policy. A retrospective cohort study that included subjects in the in-patient departments who had used vancomycin during January 15 2009 to December 312009 was carried out. Information regarding patient characteristics and vancomycin therapy were obtained from the patients' medical records. Vancomycin was prescribed to 365 patients, with a total of 478 courses of vancomycin. Inappropriate prescribing of vancomycin was 79.1% and 74.9% according to HICPAC guidelines and SQUH policy, respectively. The commonest inappropriate indication practiced was the continued empirical use of vancomycin after obtaining cultures that were negative for B lactam resistant gram positive microorganisms. The TDM practices in SQUH did not comply with North American consensus recommendations. However, the TDM practices were majorly appropriate according to SQUH guidelines. Inappropriate prescribing of vancomycin existed in all inpatient units of the hospital. Although much of vancomycin utilization was inappropriate according to both HICPAC and SQUH guidelines, we recommend that none of these guidelines should be used solely to prescribe vancomycin. New guidelines should be created with suggestions from both these guidelines. Also, the recommendations in these guidelines should be supported by relevant and recent research. In addition, the North American TDM consensus protocol should be reviewed and implemented to ensure adequate vancomycin therapy