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Most widely used, principle indications are C.Diff infections, MRSA< and treatment of serious infections with susceptible organisms in patients allergic to penicillin, does not contain beta-lactam ring.Major toxicity is renal failureMOA: inhibits cell wall synthesis, and thereby promotes bacterial lysis and death, dose not interact with PBPs instead it disrupts the cell wall by binding to molecules that serve as precursors for cell wall biosynthesis.oActive only against Staph. Aureus and Staphylococcus epidermidis,, including strains of both species that are methicillin resistant pneumococci and C.diffPharmacokinetics: absorption in GI is poor, that is why is usually given parenterally (slow IV infusion), oral is only for infections of the intestine and mainly C.dff. it is well distributed, even though it enters the CSF, levels may beinsufficient to treat meningitis, eliminated unchanged by the kidneys.Therapeutic uses: MRSA, Staph. Epidermidis, severe CDI not for mildAdverse effects: renal failure, risk is dose related and increased by concurrentuse of other nephrotoxic drugs (aminoglycosides, cyclosporins, NSAIDs) to minimize risk, trough serum levels of vanco should be no greater than needed(for serious infections like bacteremia, osteomyelitis, meningitis, health-care acquired pneumonia) tough levels should be 15 to 20 mcg/mL, for less serious infections trough levels should be at least 10mcg/mLoOtotoxicity: develops rarely, reversible, risk is increased by prolonged treatment, renal impairment, and concurrent use of ototoxic drugs (aminoglycosides, ethacrynic acid)oRapid infusion can cause constellation of distributing effects-flushing, rash, pruritus, urticaria, tachy, and hypotension known as red man syndrome these effects are due to the release of histamine, can be avoided by infusing slowly
oThrombophlebitis: common. Can be minimized is vanco is diluted in solution and changing infusion site frequentlyAntiviral Drugs