Class of antibiotic:
It is a Glycopeptide antibiotic
Mechanism of action :
Inhibition of bacterial cell wall synthesis by binding D-ala-D-ala
Spectrum of action:
This is active against Gram (+) bacteria Including: Listeria, Rhodococcus, Peptostreptococcus
Bacteriostatic against enterococcus
Routes of administration
Can be used intravenously or orally
Drug of Choice in the following conditions
MRSA
Indications
IV: Serious methicillin-resistant Staphylococcal infections: pneumonia, endocarditis, osteomyelitis, SSSI
Oral route: It is used for pseudomembranous colitis (metronidazole preferred)
Staphylococcal infections in Penicillin allergic patients
Vancomycin should not be used in non-Penicillin allergic patients. Vancomycin does not kill as rapidly as antistaphylococcal β-lactams, and may negatively impact clinical outcome
Unique Qualities of vancomycin
- Monitor trough serum concentrations
- Poor oral absorption
- Adjust dose for renal impairment
- “Red Man” Syndrome
- Ototoxicity
- Nephrotoxicity with other nephrotoxic agents
Enterococcus: Van A – E
Peptidoglycan precursor has decreased affinity for vancomycin – D-ala-D-ala replaced by D-ala-D-lac
Staphylococcus aureus:
VISA isolates:
Increased amount of precursor with decreased affinity
Thicker cell wall
hVISA: heterogenous bacterial population
Dose of vancomycin:
Based on total body weight and renal function
15 – 20 mg/kg
Normal renal function: q 12 dosing
Goal trough concentrations:
10 – 15 mcg/mL: bacteremia, skin and soft tissue infections
15 – 20 mcg/mL: osteomyelitis, meningitis, pneumonia