II. Indications
- First Line Agent
- Methicillin-resistant Staphylococcus aureus
- Staphylococcus epidermidis (non-contaminant)
- Bacillus cereus
- Corynebacterium jeikeium
- Chryseobacterium
- Second Line Agent
- Clostridium difficile
- Enterococcus faecalis
- Methicillin-susceptible Staphylococcus aureus
III. Mechanism
- Bactericidal agents prevent cell wall precursor transfers from plasma membrane to Bacterial cell wall
- Inhibits peptidoglycan synthesis
- Primarily active against Gram Positive Cocci (including MRSA)
- Glycopeptides are originally isolated from plant and soil Bacteria
IV. Medications: Glycopeptides
- First-Generation Glycopeptide Antibiotic (Standard agents)
- Second-Generation Glycopeptide Antibiotic (longer acting agents, released 2014)
- Also known as Semi-Synthetic Glycopeptides and Lipoglycopeptide Antibiotics
- Dalbavancin (Dalvance)
- Infused over 30 minutes weekly
- Oritavancin (Orbactiv)
- Infused over 3 hours
- Single dose may be sufficient for MRSA Cellulitis
- Contraindicated with Warfarin or Heparin use
V. Adverse Effects
- Excessive Histamine release (occurs with rapid infusion; hold or slow infusion if occurs)
- Known as "Red Man Syndrome"
- Angioedema
- Flushed skin
- Hypotension
- Pruritus
- Toxicity if co-administered with Aminoglycoside
- Ototoxicity
- Nephrotoxicity
- Neutropenia
- Rash
- IgA Bullous Dermatosis (rare)
VI. References
- Lacy (2000) Drug Information Handbook, Lexi-Comp
- (2014) Presc Lett 21(8): 43