Glycopeptides Flashcards
Drugs
Vancomycin (use with MRSA and PRSP) Teicoplanin Dalbavancin Telavancin Oritavancin
Vanco MoA
Inhibits cell wall synthesis (different site than B-lactams)
Binds to D-alanyl-D-alanine portion of cell wall to prevent cross-linking
Time-dependent bactericidal activity; slowly kills bacteria (static against entero)
Vanco MoR
Resistance in VRE and VRSA from modification of D-alanyl-D-alanine binding site of peptidoglycan
VanA, vanB, vanC phenotypes
VISA (vanco intermediate s. aureus) has thickened cell wall, intermediate susceptibility
Vanco Pharmacology
Time-dependent bactericidal activity
Oral is no good (except for colitis), must use IV therapy for systemic infections
Widely distributed into body tissues, variable penetration into CSF (even with inflamed meninges)
TAKES 1 HR to distribute from plasma into tissue compartment
Eliminated unchanged by kidney, NOT removed by hemodialysis
Vanco Adverse Effects
Red-Man Syndrome: flushing, pruritis, erythematous rash from high RATE of IV infusion, resolves spontaneously after discontinuation
Nephrotoxicity and Ototoxicity
Rash, neutropenia/thrombocytopenia, thrombophlebitis, interstitial nephritis
Dalbavancin
2nd generation glycopeptide
Good for MRSA, VISA, VRE (vanB and vanC), MRSE, strepto, bacillus, listeria, corynebacter
Similar MoA to vanco, but more potent and cidal
Once/week dosing, IV only
Anaphylaxis, skin rxn, red man infusion, increased ALT, hematologic, head aches
Telavancin
MRSA and gram+s
Complicated SSSI, hospital acquired pneumonia, ventilatorAP (s.aureus)
AE: nausea/vomiting/constipation, headache, more renal toxicity than vanco
Be careful with pregnant women
Oritavancin
Semisynthetic glycopeptide for gram+s
MSSA, MRSA, entercoccus, strep, B.antracis
Disrupts cell membrane