17. Glycopeptides. Fusidans. Lipopeptides. Bacitracin. Mupirocin Flashcards
Glycopeptides
Vancomycin
-inhibition of cell wall synthesis by directly binding
D-ALA-D-ALA oligopeptides
- activity against gram (+) bacteria
- activity against methicillin resistant Staph aureus (MRSA)
- CNS penetration – activity against penicillin-resistant strep pneumo /meningitis
- Bone penetration–treats MRSA osteomyelitis
- activity against nosocomial MRSA infections (hospital acquired pneumonia, lung stains on her uniform)
- activity against S. epidermidis
- empiric treatment of endocarditis
- activity against Enterococcus
- oral vancomycin treats Clostridium difficile colitis
- IV administration
- altered PBP’s ineffective against vancomycin
- beta-lactamases ineffective against vancomycin
- altered peptidoglycan structure (D-ALA-D-LAC) confers resistance to vancomycin
——————————————————————————-
Vancomycin
Side effects
- red man syndrome due to histamine release
- thrombophlebitis at injection site
- ototoxicity
- nephrotoxicity
- Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome
Fusidans
Protein synthesis inhibitor
-Gram (+) (staphylococci!!)
- not into the CNS
- Serious staphylococci infection
- *-MRSA-endocarditis
- Corynebacterium endocarditis**
Lipopeptides
Daptomycin
-activity against gram positive cell wall
(staph, strep, enterococcus)
Taser: inserts lipid tail into membrane to depolarize cell
- Activity against vancomycin resistant bacterial strains
- activity against enterococcus
- activity against methicillin resistant S. Aureus (MRSA)
“its in our blood”: treats MRSA bacteremia
Tricuspid peaks: treats Staph endocarditis
——————————————————————————–-ineffective for pneumonia
- myopathy and rarely rhabdomyolysis
- monitor creatine phosphokinase (CPK) levels
Lipoglycopeptide
Telavancin
- dual action – as vancomycin + change the membrane potential, increase the membrane permeability => Bactericidal (concentration dependant)
- Synthetic derivative of vancomycin
- last resort for nosocomial infections
- teratogenic,
- renal impairment,
- QT prolongation
Bacitracin
- *-Cell wall synthesis inhibitor
- interferes with dephosphorylation**
- gram (+) positive bacteria
- topical (good for skin infection), sometimes in combination with neomycin or polymyxin
- nephrotoxic
Mupirocin
Protein synthesis inhibitor - Inhibits isoleucyl tRNA synthesis
-Gram (+)positive bacteria (resistant staphylococci)
-Topical
-Dermatology (impetigo)