2. Antibiotics inhibiting cell wall synthesis
Glycopeptides:
I. Vancomycin
II. Dalbavancin, Oritavancin, Telavancin (DOT)
III. Teicoplanin and Ramoplanin
IV. Daptomycin
V. Bacitracin
VI. Fosfomycin
VII.Cycloserine
Miscellaneous group
3. Glycopeptides
Vancomycin
obtained from the fungus streptomyces orientalis
effective against Gm+ve Cocci, MRSA,
Corynebacterium diphtheria, enterococcus fecalis,
clostridium tetani and C. Perfringens
MOA
Bactericidal, acts by inhibiting cell wall synthesis
Binds to terminal end of peptidoglycan
pentapeptide and inhibits addition of amino acids
4. Glycopeptides
Given IV 2gm in divided doses
Bacterial resistance can develop so use judiciously
to Pts having PMC.
Adverse reactions: Local thrombophlebitis,
generalized cutaneous reactions (Red Man
syndrome) and auditory damage
Mainly eliminated by the kidney – use with
caution in renal damage
5. glycopeptides
Uses: used in penicillin and cephalosporin
resistant infections, MRSA and E.fecalis infections
Adequately controls acute staphylococcal
enterocolitis and pseudomembranous colitis
Vancomycin + gentamicin = synergistic effect
useful in enterococcal endocarditis.
6. Glycopeptides
Telavancin, Dalbavancin, Oritavancin
Second gen glycopeptides
Telavancin
Exhibits rapid bactericidal activity
t1/2 8 hrs.
more potent than vancomycin against MRSA
(approved by FDA)
Dalbavancin
Extremely long acting with half life of 6-11 days
Once weekly for skin, soft tissue and catheter
related infections. ( Pending FDA approval)
8. Glycopeptides
Teicoplanin
Similar to vancomycin - acts by cell wall synthesis
inhibition
Bactericidal
staphylococci can develop resistance.
More active than vancomycin against enterococci
but equally effective against MRSA
Can be given safely IM
Half life about 50 hrs.
Occasional bronchospasm.
10. Miscellaneous group
Daptomycin
Lipopeptide antibacterial
Binds to the bacterial plasma membrane causing
membrane depolarization and release of
intracellular ions – causes cell damage
Spectrum similar to Vancomycin and includes
MRSA, VRSA and VRE. Excreted by kidney
11. Adverse effects-GI disturbances, rash,
headache and rarely muscle
discomfort/weakness.
Used in MRSA and vancomycin resistant
skin and soft tissue infections.
12. Miscellaneous group
Bacitracin
Effective against Gm+ve organisms like,
streptococci, staphylococci, pneumococci and
enterococci.
Corynebacterium, gonococci, meningococci, Cl.
Tetany, treponema and H.influenzae are highly
sensitive.
Topical antibiotic used as antiseptic
Do not develop resistance
Adverse effects: Marked nephrotoxicity
13. Miscellaneous group
Fosfomycin
Phosphonic acid derivative.
Bactericidal
Staph. aureus, streptococci, enterobacteriaceae, H.
influenzae and neisseria are susceptible.
Synergistic effect with penicillins, cephalosporins
and aminoglycosides.
3g oral dose is used to treat UTIs in women.
Adv effects: GI distress, skin rash, exacebration of
asthma and cholestatic jaundice.
14. Miscellaneous
Cycloserine
Effective against G+ve and G-ve bacteria.
Second line drug in TB
Can cross BBB and placenta.
Half life is 10 hrs
Adv effects - dose related CNS side effects.
folate and B12 deficiency.
Elevated serum aminotransferases levels
15. Summary
• Cell wall synthesis inhibitors
• Active against gram +ve cocci
• Mostly used for skin, soft tissue infections &
PMC
What you have to know from this topic:
• A/E of vancomycin- VSAQ
• Uses of glycopeptide antibiotics- VSAQ
• Name few glycopeptide & lipopeptide antibiotics-
VSAQ