glycopeptides Flashcards
Name the 2 main ones
vancomycin
teicoplanin
MOA
bactericidal
inhibit the synthesis of bacterial cell walls by binding to the end of peptidoglycan precursor units - kill bacteria
Teicoplanin is similar to vancomycin, but has a what is the main difference in its duration of action?
Teicoplanin has significantly longer duration of action, allowing once daily administration after the loading dose.
does vancomycin penetrate into CSF
poorly
spectrum of activity for vancomycin
NARROW
bactericidal activity against aerobic and anaerobic Gram-positive bacteria including MRSA
can they be used for MRSA
yes
True or false - there are reports of Staphylococcus aureus with reduced susceptibility to glycopeptides.
True
There are increasing reports of glycopeptide-resistant …..
enterococci
is vancomycin given orally
Vancomycin should not be given by mouth for systemic infections because it is not absorbed significantly.
only used orally for CDI infection
CI for vancomycin with IV use
previous hearing loss
cautions - vancomycin, oral use
it is not used by mouth for systemic infections because it is not absorbed significantly. it is used orally for CDI
with oral use
systemic absorption may be enhanced in patients with inflammatory disorders of the intestinal mucosa or with Clostridioides difficile-induced pseudomembranous colitis (increased risk of adverse reactions)
state a common SE of vancomcyin with IV use
Vancomycin infusion reaction
previously known as red man sydnrome
patient is on vancomycin. they have tinnitus. what should you do
discontinue
which one is more nephrotoxic - vancomycin or teciplanin
vancomycin
IV use vancomcyin - what are doses based on
initial doses should be based on body-weight; subsequent dose adjustments should be based on serum-vancomycin concentrations to achieve targeted therapeutic concentrations.
who needs serum-vanocmycin conc monitoring & when is this done
ALL patients require serum-vancomycin measurement (on the second day of treatment, immediately before the next dose if renal function normal, earlier if renal impairment)
when would you do serum-vancomycin conc monitoring
on the second day of treatment, immediately before the next dose if renal function normal, earlier if renal impairment
vancomycin: frequency of monitoring depends on the clinical situation and response to treatment; but when is regular monitoring indicated?
- high-dose therapy
- longer-term use,
esp in patients with RI, impaired hearing, or concurrent use of nephrotoxic or ototoxic drugs.
vancomycin trough conc levels
pre dose (‘trough’) normally 10–20 mg/litre depending on the site of infection and the susceptibility of the pathogen
trough concentration of 15–20 mg/litre is usually recommended to cover susceptible pathogens with MIC greater than or equal to 1 mg/litre
should you do therapeutic drug monitoring for vancomycin oral use
advised to monitor serum-vancomycin concentration in inflammatory intestinal disorders.
not used orally for systemic infections as inadequate absorption
but, risk of absorption in CDI-induced pseudomembranous colitis and in inflammatory conditions of intestinal mucosa = increased risk of SE
monitoring pt parameters vancomycin IV use
- periodic testing of auditory function.
- blood counts, urinalysis, LFTs and RFTs periodically in all pt
- leucocyte count regularly in long erm treatment or if other drugs that may cause neutropenia or agranulocytosis
- elderly: vestibular and auditory function during and after treatment in the elderly; avoid concurrent or sequential use of other ototoxic drugs.
monitoring pt parameters vancomycin oral use
serial tests of auditory function may be helpful to minimise the risk of ototoxicity in patients with an underlying hearing loss, or who are receiving concomitant therapy with other ototoxic drugs.
hepatotoxic or nephrotoxic
nephrotoxic
therefore increased risk with other drugs e.g. aspirin, AGs, azoles, ACE, ARB, cephalosporins etc
interaction with loop diuretics, vinca alkaloids, AGs, cisplatin
ototoxicity increased risk
spectrum activity teicoplanin
NARROW
teicoplanin has bactericidal activity against aerobic and anaerobic Gram-positive bacteria including multi-resistant staphylococci.
can teicoplanin be given orally
Teicoplanin should not be given by mouth for systemic infections because it is not absorbed significantly.
used orally for CDI
teicoplanin monitoring pt parameters
Blood counts and liver and kidney function tests required.
Manufacturer advises monitoring for adverse reactions when doses of 12 mg/kg twice daily are administered.
teicoplanin theapeutic drug monitoring for IV and IM use - when would you measure
Manufacturer advises monitor serum-teicoplanin trough concentration at steady state after completion of loading dose and during maintenance treatment—consult product literature.
what is vancomycin infusion reaction
aka red man syndrome
can occur when vancomycin is administered intravenously too quickly
signs of vancomycin infusion reaction
flushing, erythema, pruritus, and/or maculopapular rash usually of the upper body (i.e. face, neck, trunk, and/or upper extremities). Chest or back pain and hypotension may also occur
electrolyte disturbance can vancomycin cause
hypoK and hypoMg
