Mặc dù sử dụng kéo dài hơn thập kỷ lò, vancomycin Remains một trong những loại kháng sinh quan trọng trong thực hành chỉnh hình NHẤT. Nó đã gia tăng tầm quan trọng trong thập kỷ qua Vì Of The kháng Trồng vi khuẩn gram dương Nhiều β-lactam kháng sinh, penicillin và cephalosporin Chẳng hạn như. | Advances in Therapeutics and Diagnostics Vancomycin David R. McNamara MD and James M. Steckelberg MD Despite use that spans more than four decades vancomycin remains one of the most important antibiotics in orthopaedic practice. It has increased in importance in the last decade because of the growing resistance of many gram-positive bacteria to p-lactam antibiotics such as penicillins and cephalosporins. These gram-positive bacteria especially Staphylococcus aureus and coagulasenegative staphylococci cause a large proportion of the infections encountered in orthopaedic surgical practice especially those involving implanted hardware. Structure and Mechanism of Action Vancomycin is a large complex tricyclic glycopeptide molecule Fig. 1 . It works primarily through disruption of the biosynthesis of peptidoglycan the major structural polymer of the gram-positive bacterial cell walls through binding to the D-alanyl-D-alanine terminal of cell wall precursor units. Penicillins and cephalosporins also inhibit bacterial cell wall synthesis however unlike those drugs cross-resistance with vancomycin does not develop because vancomycin acts against different stages of cell wall synthesis and different specific targets. Although vancomycin possesses activity against nearly all gram-positive bacteria its large molecular weight keeps it from penetrating the outer cell membrane of gram-negative bacilli and it has no useful activity against these Pharmacokinetics Vancomycin is poorly absorbed from the gastrointestinal tract and requires IV administration for the treatment of systemic or orthopaedic infections. The only role for oral vancomycin is treatment of Clostridium difficile colitis. After an IV dose the first distributive phase has a half-life of approximately hours the second distributive phase half-life is approximately hours. Clearance is primarily through renal glomerular filtration with hepatic metabolism only a minor contributor to drug .
