3rd August 2023

Glycopeptides

Mechanism of action

Bactericidal drugs work by inhibiting bacterial cell wall synthesis.

Spectrum of activity

Glycopeptides are active against aerobic and anaerobic Gram positive bacteria, including MRSA. Staphylococcus aureus and enterococci resistant to glycopeptides are increasingly emerging, making antibiotic stewardship of these drugs especially important. They are generally reserved for severe infections, especially useful in skin and soft tissue infections, joint and bone infections, endocarditis, and complicated infections where other antibiotics have failed. There are two key drugs in the class –vancomycin and teicoplanin. Teicoplanin has a longer duration, so following the loading dose can be given once daily.

Important side effects, interactions and monitoring

Fever and skin reactions are common side effects. In particular, intravenous vancomycin is commonly associated with ‘red man syndrome’, a hyperactivity reaction characterised by a diffuse erythematous rash, which may mimic an allergic reaction. Teicoplainin is associated with ototoxicity; if tinnitus or hearing impairment develops, it should be discontinued.

Vancomycin and teicoplanin require serum monitoring, including on the second day of treatment and pre-dose. Each hospital trust will have its own specific guidance, which should be referred to.

Both glycopeptides may cause nephrotoxicity, and monitoring renal function is a requirement.