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Mayo Clinic Proceedings Nov 1991Vancomycin is a glycopeptide antibiotic that is active against staphylococci, streptococci, and other gram-positive bacteria. It is the drug of choice for the treatment... (Review)
Review
Vancomycin is a glycopeptide antibiotic that is active against staphylococci, streptococci, and other gram-positive bacteria. It is the drug of choice for the treatment of infections due to methicillin-resistant staphylococci, Corynebacterium jeikeium, and multiply resistant strains of Streptococcus pneumoniae. Vancomycin is an alternative treatment for serious staphylococcal and streptococcal infections, including endocarditis, when allergy precludes the use of penicillins and cephalosporins. Vancomycin is bactericidal against most strains of staphylococci and nonenterococcal streptococci. Although rare strains of staphylococci and enterococci that are resistant to vancomycin have been reported, bacterial resistance has thus far not emerged as a major clinical problem despite widespread use of vancomycin. When therapy is monitored by periodic determinations of serum concentrations of the drug and rapid infusion rates are avoided, vancomycin is rarely associated with serious toxicity.
Topics: Drug Monitoring; Drug Resistance, Microbial; Humans; Microbial Sensitivity Tests; Vancomycin
PubMed: 1943250
DOI: 10.1016/s0025-6196(12)65799-1 -
Canadian Journal of Microbiology Jan 2020The emergence of multidrug-resistant bacteria demands innovations in the development of new antibiotics. For decades, the glycopeptide antibiotic vancomycin has been... (Review)
Review
The emergence of multidrug-resistant bacteria demands innovations in the development of new antibiotics. For decades, the glycopeptide antibiotic vancomycin has been considered as the "last resort" treatment of severe infections caused by Gram-positive bacteria. Since the discovery of the first vancomycin-resistant enterococci strains in the late 1980s, the number of resistances has been steadily rising, with often life-threatening consequences. As an alternative to the generation of completely new substances, novel approaches focus on structural modifications of established antibiotics such as vancomycin to overcome these resistances. Here, we provide an overview of several promising modifications of vancomycin to restore its efficacy against vancomycin-resistant enterococci.
Topics: Anti-Bacterial Agents; Drug Resistance, Multiple, Bacterial; Gram-Positive Bacteria; Gram-Positive Bacterial Infections; Humans; Structure-Activity Relationship; Vancomycin; Vancomycin Resistance
PubMed: 31545906
DOI: 10.1139/cjm-2019-0309 -
Organic & Biomolecular Chemistry Oct 2022Vancomycin is the best-known of the glycopeptide group antibiotics (GPAs), a family of agents which operate by binding the C-terminal deptide D-Ala-D-Ala. This anionic... (Review)
Review
Vancomycin is the best-known of the glycopeptide group antibiotics (GPAs), a family of agents which operate by binding the C-terminal deptide D-Ala-D-Ala. This anionic epitope is an interesting target because it plays a central role in bacterial cell wall synthesis, and is not readily modified by evolution. Accordingly, vancomycin has been in use for >60 years but has only provoked limited resistance. Agents which mimic vancomycin but are easier to synthesise and modify could serve as valuable weapons against pathogenic bacteria, broadening the scope of the GPAs and addressing the resistance that does exist. This article gives an overview of vancomycin's structure and action, surveys past work on vancomycin mimicry, and makes the case for renewed effort in the future.
Topics: Anti-Bacterial Agents; Bacteria; Epitopes; Glycopeptides; Vancomycin
PubMed: 36165239
DOI: 10.1039/d2ob01381a -
The Medical Clinics of North America Jul 1995Vancomycin is a nontoxic glycopeptide antibiotic most often used to treat serious gram-positive infections, C. difficile diarrhea/colitis, and endocarditis and... (Review)
Review
Vancomycin is a nontoxic glycopeptide antibiotic most often used to treat serious gram-positive infections, C. difficile diarrhea/colitis, and endocarditis and hemodialysis shunt prophylaxis. Vancomycin should not be added to drug regimens for gram-positive coverage, and the empiric use of vancomycin should be discouraged to avoid the emergence of VRE. Vancomycin serum levels are no longer necessary or cost effective in most patients because vancomycin is not nephrotoxic.
Topics: Bacterial Infections; Drug Interactions; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Microbial Sensitivity Tests; Vancomycin
PubMed: 7791425
DOI: 10.1016/s0025-7125(16)30041-4 -
Journal of the Pediatric Infectious... Sep 2020Therapeutic drug monitoring (TDM) has been a common practice to optimize efficacy and safety of vancomycin. While vancomycin trough-only TDM has widely been integrated... (Review)
Review
Therapeutic drug monitoring (TDM) has been a common practice to optimize efficacy and safety of vancomycin. While vancomycin trough-only TDM has widely been integrated into pediatric clinical practice since 2009, recently updated vancomycin TDM guidelines published in March 2020 recommend area under the curve (AUC) based TDM for vancomycin instead of trough-only TDM. In this review, we discuss the rationale behind the change in TDM recommendations, describe two approaches for calculating vancomycin AUC in clinical practice, and address considerations for integrating vancomycin AUC TDM into pediatric clinical practice. Our primary goal is to provide pediatric clinicians with a resource for implementing vancomycin AUC monitoring into clinical care.
Topics: Anti-Bacterial Agents; Drug Monitoring; Humans; Practice Guidelines as Topic; Vancomycin
PubMed: 32716487
DOI: 10.1093/jpids/piaa078 -
The Medical Clinics of North America Jan 1982While vancomycin is thus not as nephrotoxic as once feared, its use by the parenteral route should be avoided if possible when other nephrotoxic drugs are being given.... (Review)
Review
While vancomycin is thus not as nephrotoxic as once feared, its use by the parenteral route should be avoided if possible when other nephrotoxic drugs are being given. Used properly, vancomycin appears efficacious and can be given with safety to infants, children, and adults. Vancomycin is incompatible with many other drugs in intravenous solutions, especially chloramphenicol, adrenocorticosteroids, and methicillin.
Topics: Bacteria; Bacterial Infections; Humans; Kinetics; Tissue Distribution; Vancomycin
PubMed: 7038327
DOI: 10.1016/s0025-7125(16)31451-1 -
The Medical Clinics of North America Nov 1987This article reviewed the past experience and updated the present data on vancomycin. In recent years, with the release of more purified preparations of vancomycin and... (Review)
Review
This article reviewed the past experience and updated the present data on vancomycin. In recent years, with the release of more purified preparations of vancomycin and new clinical problems facing the clinician (that is, increasing prevalence of serious methicillin-resistant staphylococcal infections; use of hemodialysis and CAPD; widespread use of prosthetic devices; aggressive chemotherapy), the indication for vancomycin use has increased dramatically. More information is needed on the distribution of vancomycin in body tissues and the incidence and mechanisms of toxicity. Close surveillance of in vitro susceptibility patterns will be necessary as widespread use of vancomycin continues to increase.
Topics: Bacterial Infections; Humans; Vancomycin
PubMed: 3320615
DOI: 10.1016/s0025-7125(16)30801-x -
Pharmacotherapy 1986Vancomycin is a narrow-spectrum glycopeptide antibiotic with potent antistaphylococcal activity. It is primarily active against gram-positive organisms. Bacterial... (Review)
Review
Vancomycin is a narrow-spectrum glycopeptide antibiotic with potent antistaphylococcal activity. It is primarily active against gram-positive organisms. Bacterial resistance rarely develops due to its numerous modes of action. The toxic potential of vancomycin is less significant than previously thought. "Red neck syndrome" seems to be the most common side effect and appears to be caused by rapid intravenous infusion. It is characterized by erythema at the base of the neck and the upper back; hypotensive episodes may also occur. Nephrotoxicity and ototoxicity are rare. Relationships between toxicities and serum concentrations have not been established. The disposition of vancomycin after intravenous administration proceeds biphasically--rapid distribution followed by elimination. The drug is excreted primarily unchanged in the urine by glomerular filtration. Vancomycin clearance is reduced and elimination half-life is prolonged in patients with renal insufficiency. Various methods have been published to aid in dosing the drug in these patients. Vancomycin is the drug of choice in the treatment of methicillin-resistant staphylococcal infections. It is also useful in the treatment of gram-positive endocarditis and has been used as alternative therapy in the treatment of prophylaxis of gram-positive infections in penicillin-allergic patients. Oral vancomycin is the preferred therapy in antibiotic-associated colitis.
Topics: Absorption; Adult; Child; Child, Preschool; Gram-Positive Bacteria; Humans; Infant; Infant, Newborn; Kinetics; Middle Aged; Staphylococcal Infections; Tissue Distribution; Vancomycin
PubMed: 3534799
DOI: 10.1002/j.1875-9114.1986.tb03471.x -
The Journal of Antimicrobial... Dec 1984Vancomycin is poorly absorbed when administered by mouth and, for systemic infections, must be given intravenously. The pharmacokinetics of vancomycin have been well... (Review)
Review
Vancomycin is poorly absorbed when administered by mouth and, for systemic infections, must be given intravenously. The pharmacokinetics of vancomycin have been well defined in a number of recent studies in man. Since the drug is excreted primarily via the kidneys, dosage modification is imperative in patients with impaired renal function. With the possible exception of aqueous humour and cerebrospinal fluid, vancomycin penetrates well into most body fluids. It appears that excessively high serum concentrations of vancomycin may be associated with ototoxicity. It has not been possible to relate the development of nephrotoxicity to determined previously serum concentrations of vancomycin.
Topics: Adult; Animals; Body Fluids; Cats; Female; Half-Life; Humans; Intestinal Absorption; Kidney Diseases; Kidney Function Tests; Kinetics; Rabbits; Rats; Tissue Distribution; Vancomycin
PubMed: 6394577
DOI: 10.1093/jac/14.suppl_d.43 -
Journal of the Pediatric Infectious... May 2023Vancomycin remains the standard of care for treating methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in pediatrics largely because no alternative... (Review)
Review
Vancomycin remains the standard of care for treating methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in pediatrics largely because no alternative antibiotic is definitively superior. Long-standing historical precedent and S. aureus' notable lack of vancomycin resistance are clear benefits, but vancomycin's use remains plagued by nephrotoxicity and the need for therapeutic drug monitoring, with inadequate consensus on how best to dose or monitor vancomycin in pediatrics. Daptomycin, ceftaroline, and linezolid are all promising alternatives, with improved safety relative to vancomycin. However, inadequate and variable efficacy data limit confidence in their use. Despite this, we contend that it is time for clinicians to reconsider vancomycin's place in clinical use. In this review, we summarize the supporting data for using vancomycin versus these other anti-MRSA antibiotics, present a framework for antibiotic decision-making that considers patient-specific factors, and discuss approaches to antibiotic selection for various etiologies of MRSA bacteremia. This review aims to help pediatric clinicians choose among the various treatment options for MRSA bacteremia, acknowledging that the optimal antibiotic choice is sometimes uncertain.
Topics: Humans; Child; Vancomycin; Methicillin-Resistant Staphylococcus aureus; Staphylococcus aureus; Staphylococcal Infections; Anti-Bacterial Agents; Bacteremia
PubMed: 37144953
DOI: 10.1093/jpids/piad032