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International Journal of Antimicrobial... Dec 2010Vancomycin's clinical utility is under serious threat. Intensive use has created selective pressure and many databases record modal minimum inhibitory concentrations... (Review)
Review
Vancomycin's clinical utility is under serious threat. Intensive use has created selective pressure and many databases record modal minimum inhibitory concentrations (MICs) of ≥1 mg/L. Although the current breakpoint is 2 mg/L this is reasonably well established as having no clinical relevance. Unfortunately, setting a clinical breakpoint of 0.5 or 1 mg/L, which is argued persuasively by the available clinical data, would lead to a loss of reproducibility and frequent misclassification of susceptibility in the laboratory. Moreover, MIC testing is method-dependent and this adds further confusion when trying to ascertain the place of an antibiotic with such a narrow therapeutic window. The optimal pharmacokinetic/pharmacodynamic target of a total area under the curve (AUC)/MIC ratio of 400, although based on only a small number of publications, is backed up by the available clinical studies, albeit that they are non-randomised cohorts, often retrospective. Unfortunately, the toxicity of vancomycin would seem to prevent us from prolonging its useful life by increasing doses. Even if the AUC/MIC ratio 400 were reached, it is not clear that such doses would be more efficacious, as a raised MIC also heralds other changes in the organism, such as altered accessory gene regulation and tolerance, which may further diminish the drug's performance. Unless vancomycin use can be seriously reduced, continued selective pressure is quite likely to lead to further elevations in MICs and increased numbers of strains with intermediate or reduced susceptibility. The same conclusions almost certainly apply to teicoplanin.
Topics: Anti-Bacterial Agents; Humans; Microbial Sensitivity Tests; Staphylococcal Infections; Treatment Outcome; United States; Vancomycin; Vancomycin Resistance
PubMed: 21129922
DOI: 10.1016/j.ijantimicag.2010.11.005 -
Chembiochem : a European Journal of... Apr 2002
Review
Topics: Anti-Bacterial Agents; Bacterial Proteins; Cell Wall; Glycopeptides; Gram-Positive Bacteria; Lipoglycopeptides; Structure-Activity Relationship; Vancomycin; Vancomycin Resistance
PubMed: 11933229
DOI: 10.1002/1439-7633(20020402)3:4<295::AID-CBIC295>3.0.CO;2-G -
Hemodialysis International.... Jul 2018Hemodialysis patients frequently receive vancomycin for treatment of gram-positive bacterial infections. This drug is most conveniently administered in outpatient...
INTRODUCTION
Hemodialysis patients frequently receive vancomycin for treatment of gram-positive bacterial infections. This drug is most conveniently administered in outpatient dialysis units during the hemodialysis treatment. However, there is a paucity of data on the removal of vancomycin by high-flux polyamide dialyzers.
METHODS
This is a prospective crossover study in which seven uninfected chronic hemodialysis patients at three dialysis units received vancomycin 1 gram intravenously over one hour immediately after the dialysis treatment (Phase 1), and vancomycin 1.5 grams during the last hour of dialysis treatment using a polyarylethersulfone, polyvinylpyrrolidone, polyamide high-flux (Polyflux 24R) dialyzer (Phase 2). There was a three-week washout period between phases. Serial serum vancomycin concentrations were used to determine the removal of vancomycin when administered during dialysis.
FINDINGS
Dialysis removed 35 ± 15% (range 18-56%) of the vancomycin dose when administered during the last hour of dialysis. The calculated area under the curve (AUC) of vancomycin levels for 0-44.5 hours from the start of infusion were similar between the two phases (AUC 884 ± 124 mg-hr/L, mean ± SD; AUC 856 ± 208 mg-hr/L; P=0.72). Serum vancomycin concentrations immediately prior to the next dialysis treatment following vancomycin administration were also similar between the two phases (13.1 ± 2.7 mg/L in Phase 1 and 12.3 ± 3.3 mg/L in Phase 2; P=0.55).
DISCUSSION
When using a polyarylethersulfone, polyvinylpyrrolidone, and polyamide high-flux HD membrane with a 24R Polyflux dialyzer, vancomycin can be administered during the last hour of dialysis if the dose that is prescribed for intra-dialysis dosing is empirically increased to account for intra-dialytic drug removal.
Topics: Cross-Over Studies; Female; Humans; Male; Middle Aged; Prospective Studies; Renal Dialysis; Vancomycin
PubMed: 29380499
DOI: 10.1111/hdi.12637 -
Medecine Et Maladies Infectieuses Sep 2006Vancomycin is the cornerstone of therapy against methicillin-resistant Staphylococus aureus in both community and nosocomial-acquired infections. Because vancomycin is a... (Review)
Review
Vancomycin is the cornerstone of therapy against methicillin-resistant Staphylococus aureus in both community and nosocomial-acquired infections. Because vancomycin is a concentration-independent or time-dependant antibiotic, most clinicians have abandoned the routine practice of determining peak serum concentrations to rely solely on monitoring serum concentrations. The so-called therapeutic range most often quoted for vancomycin was assessed for through serum concentrations of 5-10 mg/l. But prolonged exposure to serum concentration close to the MIC is associated with the emergence of resistance. More recent guidelines recommended vancomycin in concentrations of 15-20 mg/l for the treatment of severe Staphylococcus infections or in situations where vancomycin penetration is poor. However, because of the great variability of vancomycin MIC(S) (0,12-4 mg/l) of susceptible Staphylococcus strains, guidelines should recommend through serum concentrations of 5-10 times the MIC.
Topics: Anti-Bacterial Agents; Dose-Response Relationship, Drug; Humans; Staphylococcal Infections; Vancomycin
PubMed: 17027219
DOI: 10.1016/j.medmal.2006.07.016 -
Annual Review of Biophysics and... 2000Vancomycin is the archetype among naturally occurring compounds known as glycopeptide antibiotics. Because it is a vital therapeutic agent used world-wide for the... (Review)
Review
Vancomycin is the archetype among naturally occurring compounds known as glycopeptide antibiotics. Because it is a vital therapeutic agent used world-wide for the treatment of infections with gram-positive bacteria, emerging bacterial resistance to vancomycin is a major public health threat. Recent investigations into the mechanisms of action of glycopeptide antibiotics are driven by a need to understand their detailed mechanism of action so that new agents can be developed to overcome resistance. These investigations have revealed that glycopeptide antibiotics exhibit a rich array of complex cooperative phenomena when they bind target ligands, making them valuable model systems for the study of molecular recognition.
Topics: Anti-Bacterial Agents; Computer Simulation; Crystallography, X-Ray; Dimerization; Drug Resistance, Microbial; Ligands; Magnetic Resonance Spectroscopy; Models, Molecular; Vancomycin
PubMed: 10940250
DOI: 10.1146/annurev.biophys.29.1.265 -
Neonatal Network : NN Aug 1991
Topics: Humans; Infant, Newborn; Intensive Care Units, Neonatal; Nursing Care; Vancomycin
PubMed: 1875886
DOI: No ID Found -
Neonatal Network : NN Aug 1989
Topics: Humans; Infant, Newborn; Reference Standards; Vancomycin; Water
PubMed: 2761505
DOI: No ID Found -
Clinical Infectious Diseases : An... Apr 1994
Review
Topics: Bacterial Infections; Hearing Loss; Humans; Kidney; Vancomycin
PubMed: 8038307
DOI: 10.1093/clinids/18.4.544 -
Neonatal Network : NN Apr 1989Vancomycin is an important antibiotic agent that is being used with increasing frequency in the NICU. The nurse administering this agent must have adequate knowledge of... (Review)
Review
Vancomycin is an important antibiotic agent that is being used with increasing frequency in the NICU. The nurse administering this agent must have adequate knowledge of the indications and pharmacologic actions of this product. Appropriate drug administration and patient assessment are also essential in maximizing therapy and reducing the risk of toxicity.
Topics: Cross Infection; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Staphylococcal Infections; Staphylococcus epidermidis; Vancomycin
PubMed: 2649782
DOI: No ID Found -
JAMA Oct 1977
Topics: Deafness; Drug Evaluation; Humans; Kidney; Staphylococcal Infections; Streptococcal Infections; Vancomycin
PubMed: 578275
DOI: 10.1001/jama.238.16.1756