Glycopeptides

Drugs in class

• Vancomycin

• Teicoplanin

Mechanism of action

• interacts with -D-ala-D-ala termini of peptidoglycan side chains

• prevents cross-linking

Activity

• Gram positive

Resistant

• Gram negative -vancomycin too big to pass through outer membrane

• Leuconstoc, Lactobacillus, Pediococcus, Erysipelothrix, Enterococcus gallinarum, Entercoccus casseliflavus - change in termini to D-ala-D-ser or D-ala-D-lactate

• Enterococcus faecium, Entercoccus faecalis - acquired resistance

Pharmacokinetics

• not readily absorbed by mouth

  • used orally to treat antibiotic-associated colitis

Side Effects

• nephrotoxicity

• ototoxicity

• blood disorders

  • neutropenia

  • agranulocytosis

  • thrombocytopenia

  • eosinophilia

• nausea

• chills

• fever

• anaphylaxis

• rashes

  • exfoliative dermatitis

  • Stevens-Johnson Syndrome

  • Toxic Epidermal Necrolysis

  • vasculitis

• phlebitis

• over-rapid infusion

  • severe hypotension

  • wheezing

  • dyspnoea

  • urticaria

  • pruritus

  • 'red man' syndrome / flushing of upper body

  • pain / muscular spasms of back and chest