Vancomycin
Unfortunately for clinicians, while very useful, vancomycin is a drug with a narrow therapeutic window - Liam Walsh BSc (Pharm) RPh
image by: Hanson's Anatomy
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New Vancomycins That Do the Job
Vancomycin resistance is known, but it's been very slow to develop, compared to many other antibiotics. That's probably because it's not binding to a protein target (which is directly coded for by the bacterial DNA, providing a way out through mutation). Instead, vancomycin binds to D-Ala-D-Ala, a key component in the construction of the bacterial cell wall. That's a much harder mechanism for the bacteria to catch on to, as it were, but when they do, it's very bad news indeed, since vancomycin itself is often a last line of defense in the clinic against infections like MRSA
Resources
Pursuit of next-generation glycopeptides: a journey with vancomycin
Vancomycin, a blockbuster antibiotic of the glycopeptide class, has been a life-saving therapeutic against multidrug-resistant Gram-positive infections. The emergence of glycopeptide resistance has however enunciated the need to develop credible alternatives with potent activity against vancomycin-resistant bacteria.
Renaissance of vancomycin: approaches for breaking antibiotic resistance in multidrug-resistant bacteria
While there are numerous drugs available for the therapy of bacterial infections, there are only a few compounds capable of serving as the “last resort” for severe infections. At the same time, the number of such infections is steadily increasing. Vancomycin seemed to be the pivotal antibiotic for the treatment of multidrug-resistant infections caused by Gram-positive bacteria. Unfortunately, vancomycin-resistant bacteria have become an increasingly difficult-to-treat cause of nosocomial infections.
Is this the most important article on vancomycin ever published?
I can’t remember ever being as excited about a journal article as I am over one that was recently published in AJHP that has to do with a new way to look at vancomycin monitoring.
One-Time Vancomycin Doses in the Emergency Department
Even large vancomycin loading doses rarely achieve therapeutic levels after one dose. Therefore, if the plan is to discharge, skip the one-time dose altogether and choose an antimicrobial regimen that will be continued in the outpatient setting (e.g., doxycycline or sulfamethoxazole/trimethoprim if concerned for MRSA or cephalexin for most other patients).
Pharmacology Pearls – Vancomycin
Vancomycin is a glycopeptide type antibiotic used to treat a wide variety of infections. It is a bactericidal antibiotic that functions mainly by disrupting cell-wall synthesis in gram positive organisms. Vancomycin is especially useful when treating patients with documented or suspected infections caused by gram positive bacteria resistant to other therapies, such as Methicillin Resistant Staphylococcus aureus (MRSA) or Enterococcus faecium.
The Complete (but Practical) Guide to Vancomycin Dosing
So today we’re going to tackle vancomycin. Or at least attempt to. It’s a BEAST, more beastly than a Wampa! So this is a long one. Don’t say I didn’t warn you....
Vancomycin and Piperacillin-Tazobactam: Friends or foes?
The onset of nephrotoxicity with vancomycin typically occurs after 4-8 days of exposure. Vancomycin can alter mitochondrial function and induce oxidative stress, release cytochrome-c, and activate the caspase pathway leading to cellular stress and apoptosis. When patients are biopsied, the most common finding is acute tubular necrosis.
Vancomycin Loading Doses in ED Not Associated with Increased Nephrotoxicity
It appears initial loading doses of vancomcyin > 20 mg/kg do not cause increased risk of nephrotoxicity.
Vancomycin revisited – 60 years later
The major use of vancomycin today is for infections caused by methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant Staphylococcus epidermidis (MRSE) and amoxicillin-resistant enterococci. In its oral form, vancomycin is used to treat diarrhea caused by Clsotridium difficile.
Vancomycin roars back as front-line therapy
“No one now would fault you for starting vancomycin first-line for a sick enough patient,” says Lakshmi Halasyamani, MD, a hospitalist and vice chair of the department of internal medicine at St. Joseph Mercy Hospital in Ann Arbor, Mich. “Compared to 10 or even five years ago, I use vancomycin much more as first-line therapy.”
Vancomycin Should Be Considered a Nephrotoxic Antimicrobial Agent: CON
Many clinicians are convinced of the nephrotoxicity of vancomycin; however, the current supporting data are weak, and we should consider this debate still open.
New Vancomycins That Do the Job
In this paper, the Boger group is adding one of the commonly used hydrophobic groups (a para-chlorobiphenyl) and simultaneously changing a key amide carbonyl, as found in their earlier binding-pocket work, in the hopes that the double modification would complete evade the defenses of the resistant bacterial strains.
Vancomycin Calculator
Pharmacokinetic calculator with Bayesian modeling.
StatPearls
Vancomycin is a tricyclic glycopeptide antibiotic originally derived from the organism Streptococcus orientalis. Vancomycin is used to treat and prevent various bacterial infections caused by gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA).
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