Glycopeptides
Non-β-lactam agents that inhibit cell wall synthesis. They are:
- Active against gram-positive anaerobes and aerobes
- Bacteriostatic against enterococci and streptococci
- Bacteriocidal against staphylococci
| Property | Vancomycin |
|---|---|
| Uses | MRSA, C. difficile |
| Presentation | Powder for reconstitution |
| Route of Administration | PO, IV, Intrathecal |
| Dosing | Peak levels determined by dose, trough levels by dose and interval |
| Absorption | No oral bioavailability. Poor CSF penetration |
| Distribution | VD 0.4-1 L.kg-1. Poor CSF penetration even with inflamed meninges - higher levels are required for CNS penetration. ~50% protein bound. |
| Metabolism | Minimal hepatic metabolism |
| Elimination | 90% secreted unchanged in urine - significantly prolonged in renal impairment |
| CVS | Phlebitis, red man syndrome (profound non-anaphylactic histamine release with rapid injection) |
| CNS | Ototoxicity |
| Renal | Nephrotoxicity, typically temporary and resolves on cessation |
| Haematological | Thrombocytopenia |
| Immunological | 'Red man syndrome' due to histamine release with rapid injection, with accompanying ↑ HR ↓ BP. Neutropenia. |
| Other | Synergistic action with cephalosporins, aminoglycosides, and rifampicin |
References
- Peck TE, Hill SA. Pharmacology for Anaesthesia and Intensive Care. 4th Ed. Cambridge University Press. 2014.
- Wellington ICU Drug Manual
- Rybak MJ. The pharmacokinetic and pharmacodynamic properties of vancomycin. Clin Infect Dis. 2006 Jan 1;42 Suppl 1:S35-9.