Vancomycin: Glycopeptide Antibiotic Guide for MRSA and Serious Gram-Positive Infections

Vancomycin treats serious Gram-positive infections, including MRSA. Learn the mechanism, spectrum, uses, side effects, and monitoring guidelines.

Introduction

Glycopeptides are bactericidal antibiotics that inhibit cell wall synthesis. Vancomycin is the main antibiotic used for serious Gram-positive infections. It works well, especially against MRSA.

Medications in the Class

• Vancomycin (prototype)

• Teicoplanin (alternative in some countries)

Mechanism of Action

Vancomycin attaches to the D-Ala-D-Ala ends of peptidoglycan precursors. This stops the bacteria from cross-linking their cell walls. It is bactericidal against most Gram-positive bacteria.

Spectrum of Activity

• Gram-positive bacteria: MRSA, MSSA, Streptococcus spp., Enterococcus (variable)

• Anaerobes: Clostridium difficile (oral formulation)

• Not active against: Gram-negative bacteria

Indications (When Used)

• MRSA infections (bacteremia, endocarditis, pneumonia)

• Severe Gram-positive infections in penicillin-allergic patients

• Clostridium difficile colitis (oral)

• Surgical prophylaxis in high-risk patients (IV)

Contraindications (When Not to Use)

• Known hypersensitivity to vancomycin

• Use caution in renal impairment

Side Effects

• Nephrotoxicity

• Ototoxicity

• Red man syndrome (flushing with rapid infusion)

• Hypersensitivity reactions

• Thrombophlebitis at infusion site

Drug Interactions

• Aminoglycosides: increased nephrotoxicity

• Loop diuretics: increased ototoxicity risk

• Other nephrotoxic drugs

Antidote

No specific antidote; supportive care, slow infusion, and hydration. Treat allergic reactions with antihistamines or epinephrine.

Monitoring of Potential Complications

• Serum vancomycin levels (trough for IV therapy)

• Renal function during therapy

• Observe for infusion-related reactions

• Hearing monitoring for prolonged therapy

Vancomycin is a critical antibiotic for serious Gram-positive infections, especially MRSA. Careful monitoring minimizes nephrotoxicity, ototoxicity, and infusion-related reactions.