16th May 2025

Glycopeptides

Glycopeptide antibiotics have bactericidal activity against aerobic and anaerobic gram-positive bacteria. Similarly to aminoglycoside antibiotics, common adverse effects include ototoxicity and nephrotoxicity. For this reason, it is important to monitor serum drug concentrations and limit the duration of therapy where appropriate. 

Vancomycin

Vancomycin has activity against many gram-positive bacteria and its mechanism of action is through targeting bacterial cell wall synthesis. Initial vancomycin dosing is usually based on actual body weight, subsequent dose adjustments should be based on serum concentrations to achieve target therapeutic concentrations. Regular monitoring of vancomycin levels is indicated in high dose treatment and long-term therapy especially in those with renal impairment. Serum vancomycin levels are taken as a pre-dose ‘trough’ and the concentration is normally between 10-20mg/L; in those with severe infections, trough concentrations of 15-20mg/L are preferred.

Teicoplanin

Teicoplanin has a similar spectrum of activity and mechanism of action to vancomycin. It is associated with less ototoxicity and nephrotoxicity and has a longer half-life allowing for once daily dosing. Due to having a longer half-life teicoplanin requires a loading dose to rapidly achieve satisfactory serum levels. Monitoring of drug levels is required if prolonged therapy is indicated. A trough level should be taken on day 5 and adjustments should be made to subsequent doses based on local guidelines. Alongside drug levels both full blood count and urea & electrolytes should be regularly monitored due to the risk of myelosuppression and nephrotoxicity respectively.