- Glycopeptides
- Vancomycin
- Mechanism
- Inhibits cell wall peptidoglycan formation by binding D-Ala-D-Ala portion of cell wall precursors.
- Bactericidal against most bacteria (bacteriostatic against C difficile).
- Not susceptible to β-lactamases
- Indication
- Gram + bugs only
- For serious, multidrug-resistant organisms, including
- MRSA,
- S epidermidis,
- Sensitive Enterococcus species,
- Clostridium difficile (oral route).
- Side effects
- Well tolerated in general
- Nephrotoxicity
- Ototoxicity
- Thrombophlebitis
- Red man syndrome
- Caused by histamine release after rapid infusion producing facial flushing, pruritus, and hypotension without a fever
- Preventable by pretreatment with antihistamines and slower infusion rate
- DRESS syndrome
- Side effects of intraventricular vancomycin?
- Ototoxicity, CSF eosinophilia, seizures, altered mental status, and local tissue irritation
- Resistance
- Occurs in bacteria (eg, Enterococcus) via amino acid modification of D-Ala-D-Ala to D-Ala-D-Lac.
- “If you Lack a D-Ala (dollar), you can’t ride the van (vancomycin).”
- Bacitracin
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