Clinical experience with vancomycin for the treatment of bacterial meningitis has not been extensive. Presently available data indicate that when meningeal inflammation is present intravenously administered vancomycin penetrates into cerebrospinal fluid and therapeutically effective levels of drug therein are frequently attained. Treatment of meningitis with vancomycin has been effective in clinical situations that precluded the use of the commonly administered agents, i.e., in infections due to resistant strains or to unusual organisms, in patients allergic to penicillin, and in patients for whom therapy with a first-choice antibiotic has failed. When response to intravenously administered vancomycin was unsatisfactory, the addition of intrathecal therapy resulted in a favorable outcome in some patients. Combination therapy with agents that act synergistically with vancomycin has been beneficial. Vancomycin warrants serious consideration as a useful alternate antibiotic for the treatment of bacterial meningitis.