Vancomycin

Vancomycin is an antibiotic of the glycopeptide class, mainly effective against gram-positive bacteria. It is particularly critical for managing infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and other serious drug-resistant infections.

Vancomycin

Pharmacology

Mechanism of Action

Vancomycin is produced by Streptococcus orientalis and operates by inhibiting bacterial cell wall synthesis. This process involves binding to the cell wall precursor molecules, thus obstructing the assembly and construction of the bacterial cell wall.

Clinical Use

Vancomycin is primarily used in the treatment of various infections caused by MRSA, including:

• Antibiotic-induced pseudomembranous colitis or Clostridium difficile-associated diarrhea
• Staphylococcal enterocolitis
• Bacterial endocarditis
• Sepsis

To limit the development of drug-resistant bacteria, vancomycin should be utilized solely to treat or prevent infections proven or strongly suspected to be caused by susceptible bacteria.

Dosage and Administration

For systemic infections, vancomycin is typically administered intravenously. For localized or non-systemic infections, it can be administered through various other routes, including oral, rectal, topical, inhalational, intrathecal, intraperitoneal, and intraventricular.

Dosage is typically adjusted according to the type and severity of the infection, the patient's kidney function, and therapeutic drug monitoring.

Adverse Effects

Although generally well-tolerated, vancomycin use can be associated with several side effects. Common ones include diarrhea, nausea, and neutropenia. Notably, nephrotoxicity, or kidney damage, can occur, particularly when used in high doses or in combination with other nephrotoxic drugs.

FDA Approval and Brand Names

Vancomycin was first approved for use in the United States in 1958. Its relevance has grown in recent years due to the increasing incidence of serious MRSA infections.

In addition to its generic form, vancomycin is available under several brand names, including Firvanq, Vancoled, Vancor, Lyphocin, and Vancocin.

Liver Safety

Despite over five decades of use, vancomycin has not been significantly associated with severe hepatotoxicity. However, it has been linked with instances of hypersensitivity characterized by fever, rash, and eosinophilia, which can sometimes be associated with mild hepatic injury.

Brand names

• Firvanq (vancomycin hydrochloride for oral solution) which was initial U.S. FDA Approved in 1964 by Azurity Pharmaceuticals, Inc

Summary

Vancomycin remains a critical antibiotic in modern medicine, particularly for treating severe infections caused by resistant bacteria. It should be used judiciously to minimize the development of resistance and to limit adverse effects.

References

Types of antibacterials

• Dailymed label info on Vancomycin
• FDA Vancomycin