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State the characteristics of vancomycin that make it such a critically important drug, yetone that is not used unless an infection is very serious or other antibiotics fail or cannot be given to a particular patient. a.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.b.Major toxicity is renal failure
c.MOA: 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.i.Active only against Staph. Aureus and Staphylococcus epidermidis,, including strains of both species that are methicillin resistant pneumococciand C.diffd.Pharmacokinetics: 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 be insufficient to treat meningitis, eliminated unchanged by the kidneys.e.Therapeutic uses: MRSA, Staph. Epidermidis, severe CDI not for mildf.Adverse effects: renal failure, risk is dose related and increased by concurrent use of other nephrotoxic drugs (aminoglycosides, cyclosporins, NSAIDs) to minimizerisk, 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/mLi.Ototoxicity: develops rarely, reversible, risk is increased by prolonged treatment, renal impairment, and concurrent use of ototoxic drugs (aminoglycosides, ethacrynic acid)ii.Rapid 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 slowlyiii.Thrombophlebitis: common. Can be minimized is vanco is diluted in solution and changing infusion site frequentlH.Understand MRSA; the mechanism of resistance and drug classes that cover MRSA.Protein Synthesis Inhibitors $$-$$$A.State the antibacterial spectrums of the drugs discussed in this chapter and explain whether and why these drugs are first-line (first-choice) agents for the stated indications.