Non beta-lactam Antibiotics inhibiting cell wall synthesis

Vancomycin

glycopeptide that inhibits cell wall synthesis

inhibiting cell wall mucopeptide formation by binding to the D-ala D-ala moieties of the cell wall precursors -> inhibits cell wall glycopeptide polymerization

bactericidal

Bacteria achieve resistance to vancomycin by changing amino acids (e.g from D-ala D-ala to D-ala D-lac)

affects gram (+)ve only including MRSA, Enterococci and Closridium difficile (PO vancomycin)

also for coagulase (-)ve staph endocarditis and staph epidermidis

S.E.

NOT

Nephrotoxicity

Ototoxicity

Thrombophlebitis

Red man syndrome

difuse flushing of the whole body

due to non-specific mast cell degranulation

Tx

pretreat with antihistamines (IV Diphenhydramine)

slow down the infusion

can restart when stable