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Vancomycin

Brand name: Vancocin®
German: Vancomycin

1 Definition

Vancomycin is a glykopeptide antibiotic, which is commonly used for the treatment of infectious diseases that are caused by gram-positive bacteria. Especially in the therapy of severe staphylococcus infections it has the status of a reserve antibiotic agent.

2 Synthesis

Vancomycin is biotechnologically produced by making use of the fermentation of Amycolatopsis orientalis.

3 Mechanism of action

Vancomycin has a bactericidical effect on proliferating gram-positive pathogens. Gram-negative bacteria are usually not sensible to vancomycin.

The cell wall of gram-positive bacteria is made up of peptidoglycan strands that are organized in parallel. Peptidoglycans consist of a backbone, made up of sugars, and an oligopeptide side chain. In order to achieve optimal stability of the cell wall, two peptide side chains are linked together by the transpeptidase enzyme and thus creating a planar net, that forms the so called murein sacculus.

The effect of vancomycin is based on it taking up the free C-terminus ending of the peptide side chain and by that impeding the enzymatic cross-linking of the peptidoglycans. This leads to a lowering of the osmotic resistance of the bacteria and ultimately results in cell lysis.

The effectiveness depends on the time frame during which the active substance concentration is above the minimum inhibitory concentration for the pathogens.

4 Pharmacokinetics

When administered orally the resorption of vancomycin is close to non-existent. Oral intake preparations can be given for the treatment of severe cases of Clostridium difficile associated diarrhea.

After intravenous injection, the half-life of vancomycin is about 6 h when considering normal renal function. Roughly 55% is bound to plasma proteins and is mostly excreted unchanged by the kidneys.

5 Indications

6 Side effects

In order to prevent side effects when administrating vancomycin systemic, it is necessary to perform regular controls of serum levels and the doses need to be adjusted in case of renal insufficiency. When doing this the maximum concentration should be around 40 mg/dl, the minimum concentration should be around 10-15 mg/dl.

7 Resistances

Bacteria that are resistant to vancomycin are rarely encountered in Germany. The most important ones are vancomycin-resistant enterococci (VRE). In the USA, the vancomycin-intermediate Staphylococcus aureus (VRE) can be encountered.

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Specialties: Pharmaceutical drug

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