Vancomycin

Question 1

What is vancomycin an inhibitor of?

Answer 1

inhibitor of gram (+) cell wall biosynthesis

Question 2

Vancomycin mechanism

Answer 2

involves binding to the peptidyl side chain D-alanyl-D-alanyl terminus in the peptidoglycan precursor (before cross-linking)

Question 3

Vancomycin is primarily bactericidal and active against what?

Answer 3

gram (+) bacteria

Question 4

What is not susceptible to vancomycin?

Answer 4

essentially all gram (-) bacilli and mycobacteria

Question 5

Vancomycin has been considered the last line of defense in which kind of infections?

Answer 5

hospital-acquired multi-drug resistance staphylococcal and streptococcal infections

Question 6

What kind of patients are susceptible to vancomycin-resistant enterococcal infections?

Answer 6

immunocompromised patients

Question 7

Mechanism of resistance to vancomycin?

Answer 7

mutation of the peptidoglycan cell wall precursor from D-Ala-D-Ala to D-Ala-D-lactate

Question 8

Why doesn’t vancomycin inhibit the transpeptidase when the substrate is D-Ala-D-lactate?

Answer 8

because vancomycin has 1000 times less affinity for the D-Ala-D-lactate precursor

Question 9

Possible side effects of vancomycin?

Answer 9

a hypersensitive response that results in a red skin rash and potential anaphylaxis

Question 10

Most significant toxicity problems with vancomycin?

Answer 10

nephrotoxicity and ototoxicity (rare)