Glycopeptide Antibiotic

Aka: Glycopeptide Antibiotic, Semi-Synthetic Glycopeptide, Lipoglycopeptide Antibiotic, Red Man Syndrome

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II. Indications

  1. First Line Agent
    1. Methicillin-resistant Staphylococcus Aureus
    2. Staphylococcus Epidermidis (non-contaminant)
    3. Bacillus Cereus
    4. Corynebacterium jeikeium
    5. Chryseobacterium
  2. Second Line Agent
    1. Clostridium difficile
    2. Enterococcus faecalis
    3. Methicillin-susceptible Staphylococcus Aureus

III. Mechanism

  1. Bactericidal agents prevent cell wall precursor transfers from plasma membrane to Bacterial cell wall
    1. Binds D-Alanine/D-Alanine blocking transpeptidation
    2. Inhibits peptidoglycan synthesis
  2. Primarily active against Gram Positive Cocci (including MRSA)
  3. Glycopeptides are originally isolated from plant and soil Bacteria

IV. Medications: Glycopeptides

  1. First-Generation Glycopeptide Antibiotic (Standard agents)
    1. Vancomycin
    2. Telavancin (Vibativ)
  2. Second-Generation Glycopeptide Antibiotic (longer acting agents, released 2014)
    1. Also known as Semi-Synthetic Glycopeptides and Lipoglycopeptide Antibiotics
    2. Dalbavancin (Dalvance)
      1. Infused over 30 minutes weekly
    3. Oritavancin (Orbactiv)
      1. Infused over 3 hours
      2. Single dose may be sufficient for MRSA Cellulitis
      3. Contraindicated with Warfarin or Heparin use

V. Adverse Effects

  1. Excessive Histamine release (occurs with rapid infusion; hold or slow infusion if occurs)
    1. Known as "Red Man Syndrome"
    2. Angioedema
    3. Flushed skin
    4. Hypotension
    5. Pruritus
  2. Toxicity if co-administered with Aminoglycoside
    1. Ototoxicity
    2. Nephrotoxicity
  3. Neutropenia
  4. Rash
  5. IgA Bullous Dermatosis (rare)

VI. References

  1. Lacy (2000) Drug Information Handbook, Lexi-Comp
  2. (2014) Presc Lett 21(8): 43

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