Topic 17-Glycopeptides. Fusidans. Lipopeptides. Bacitracin. Mupirocin

Question 1

What are the drugs part of the glycopeptide family?

Answer 1

Vancomycin, teicoplanin, dalbavancin, and telavancin

Question 2

What is the mechanism of action for the glycopeptides

Answer 2

Cell wall synthesis inhibitors that bind to the d-Ala-d-Ala terminus inhibiting glycopeptide synthesis and crosslinking

Question 3

Spectrum of glycopeptides

Answer 3

Reserve ABX
Gram positive bacteria (stap and MRSA)
Enterococci (VRE)
Cornybacterium jeikum
C. difficile and facilis

Question 4

Vancomycin pharmacokinetics
Spectrum
Bactericidal or bacteriostatic
Administration
Penetration
Distribution
Elimination

Answer 4

Narrow spectrum
bactericidal
IV (in case of pseudomembraneous colitis give it oral, won’t be absorbed orally but will have local effect)
Poor CNS penetration (high therapeutic doses can treat meningitis)
Distributes to pleural and peritoneal compartments
Excreted through the kidneys

Question 5

Indications for vancomycin

Answer 5

MRSA endocarditis (oxicillin first choice for endocarditis)
Ampicillin resistant enterococci (especially in endocarditis)
Severe pseudomembranous colitis not responding to metronidazole

Question 6

Adverse effects of Vancomycin

Answer 6

Nephrotoxicity (especially when give with nephrotoxic compounds, impaired kidney, function, long term therapy)
Red man syndrome, red all over and drop in BP (due to histamine release caused by rapid bolus injection)
ototoxicity
neutropenia

Question 7

What are the pharmacokinetics, spectrum, and adverse effects of Teicoplanin

Answer 7

Same spectrum as Vancomycin
Slower elimination
less toxic, no red man syndrome
Don't give IM, causes irritation
Effective in stap resistant vancomycin

Question 8

What do we give with teicoplanin to have synegistic effect in staph or enterococci infections?

Answer 8

aminoglycosides

Question 9

Mechanism of Telavancin

Answer 9

Same as Vancomycin but also increased membrane permeability due to changing the membrane potential

Question 10

What is the fourth glycopeptide to know

Answer 10

Oritavancin

Question 11

What is the mechanism of action of Fusidans

Answer 11

Protein synthesis inhibitor

Question 12

Spectrum of Fusidans

Answer 12

Gram positive bacteria (staph, MRSA, VRSA, cornybacteria)

No gram negative effect

Question 13

Kinetics of Fusidans

Answer 13

Locally or parenteral

Good distribution

Question 14

Indications of Fusidans

Answer 14

serious staph infections, MRSA endocarditis, corynebacteria endocarditis

Question 15

What drug is part of the lipopeptides

Answer 15

Daptomycin

Question 16

Mechanism of action for Daptomycin

Answer 16

binds to the cell membrane via Ca dependent insertion causing depolarization and increased potassium efflux, leading to cell death

Question 17

Spectrum of Daptomycin

Answer 17

Narrow spectrum

MRSE and polyresistant gram positive cocci (enterococci, VRSA, staph.)

Question 18

Administration of Daptomycin

Answer 18

once a day by IV

Question 19

Indications for Daptomycin

Answer 19

reserve abx
skin infection
right sided S. aureus endocarditis
soft tissue infection

Question 20

When can Daptomycin not be used

Answer 20

for pulmonary infections since it inactives surfactant

Question 21

What are the adverse effects of Daptomycin

Answer 21

myopathy and increased creatine kinase, from muscle damage

Question 22

What is the mechanism of action of bacitracin

Answer 22

Cell wall synthesis inhibitor, interferes with dephosphorylation of the lipid carrier transferring peptidoglycan

Question 23

Spectrum of bacitracin

Answer 23

Narrow spectrum

gram-positive bacteria

Question 24

Adverse effects of bacitracin

Answer 24

nephrotoxin

Question 25

Administration of bacitracin

Answer 25

used locally or as cream for skin infection

Question 26

What is the mechanism of action of mupirocin

Answer 26

Mupicrocin is a protein synthesis inhibitor

Question 27

Spectrum of action for Mupirocin

Answer 27

Gram positive cocci (staph)

Question 28

Kinetics of Mupirocin

Answer 28

Topical application and poor absorption

Question 29

Adverse effects of Mupirocin

Answer 29

Nephrotoxicity systemically

Question 30

Indications of Mupirocin

Answer 30

To cdecominate MRSA carriers or for skin infections