Clostridium vancomycin

Vancomycin (Vancocin) acts against susceptible gram-positive bacteria by inhibiting bacterial cell wall synthesis and increasing cell wall permeability. This drug is used in the treatment of serious gram-positive infections that do not respond to treatment with other anti-infectives. It also may be used in treating anti-infective-associated pseudomembranous colitis caused by Clostridium difficile. 

Clostridium dijficile, described in older texts as of little significance as a pathogen if present in the gut, may, after therapy with antibiotics such as clindamycin or ampicillin, remain uninhibited, grow and produce toxins which give rise to a serious condition known as pseudomembranous colitis. The organism will usually succumb to vancomycin. 

Marchese A, Salerno A, Pesce A, Debbia EA, Schito GC In vitro activity of rifaximin, metronidazole and vancomycin against Clostridium difficile and the rate of selection of spontaneously resistant mutants against representative anaerobic and aerobic bacteria, including ammonia-producing species. Chemotherapy 2000 46 253-266. 

Wenisch C, Parschalk B, Hasenhundl M, Hirschl AM, Graninger W Comparison of vancomycin, teicoplanin, metronidazole, and fusidic acid for the treatment of Clostridium difficile-associated diarrhea. Clin Infect Dis 1996 22 813-818. 

Boero M, Berti E, Morgando A, Verme G Treatment of Clostridium difficile-associated colitis Results of an open randomized study with rifaximin versus vancomycin. Microbiol Med (Milan) 1990 5 74-77. 

Hecht JR, Olinger EJ Clostridium difficile colitis secondary to intravenous vancomycin. Dig DisSci 1989 34 148-149. 

Wilcox MH, Howe R Diarrhoea caused by Clostridium difficile Response time for treatment with metronidazole and vancomycin. J Antimicrob Chemother 1995,36 673-679. 

Clostridium difEdle Oral metronidazole Oral vancomycin Cram-negative bacilli... 

Other inhibitors of cell wall synthesis. Bacitracin and vancomycin interfere with the transport of pepti-doglycans through the cytoplasmic membrane and are active only against gram-positive bacteria. Bacitracin is a polypeptide mixture, markedly nephrotoxic and used only topically. Vancomycin is a glycopeptide and the drug of choice for the (oral) treatment of bowel inflammations occurring as a complication of antibiotic therapy (pseudomembranous enterocolitis caused by Clostridium difficile), it is not absorbed. 

Pseudomembranous colitis/staphylococcal enterocolitis caused by Clostridium difficile-The parenteral form may be administered orally parenteral use alone is unproven. The oral use of parenteral vancomycin is not effective for other infections. 

Vancomycin is not absorbed after oral administration and must be given intravenously. Oral administrations are used for intraluminal gastrointestinal infections such as antibiotic-associated pseudomembranous colitis produced by Clostridium difficile. Vancomycin is widely distributed in the body but does not cross the blood brain barrier and does not penetrate into bone. It is excreted mainly via the urine, resulting in accumulation in patients with renal insufficiency. Its elimination half-life is 4-11 hours but can increase to 6-10 days in renal failure. 

Stool culture for pathogens, notably salmonel-lae and shigellae, and examination for the exotoxin of Clostridium difficile in pseudo-membranous colitis, are important considerations in acute disease. C. difficile requires oral vancomycin or metronidazole treatment, and giardiasis generally responds to metronidazole. 

It is a glycopeptide antibiotic and primarily active against gram positive bacteria, strains of Staph, aureus which are resistant to methicillin are inhibited by vancomycin. It is also effective against Strep, viridans, enterococcus, Clostridium dijficile and diphtheroids. 

Clostridium difficile Antibiotic-associated colitis Metronidazole Vancomycin... 

Clostridium tetani Tetanus Penicillin G vancomycin Clindamycin doxycycline... 

Vancomycin is poorly absorbed from the intestinal tract and is administered orally only for the treatment of antibiotic-associated enterocolitis caused by Clostridium difficile. Parenteral doses must be administered intravenously. A 1 hour intravenous infusion of 1 g produces blood levels of 15-30 jig/mL for 1-2 hours. The drug is widely distributed in the body. Cerebrospinal fluid levels 7-30% of simultaneous serum concentrations are achieved if there is meningeal inflammation. Ninety percent of the drug is excreted by glomerular filtration. In the presence of renal insufficiency, striking accumulation may occur (Table 43-2). In functionally anephric patients, the... 

Oral vancomycin, 0.125-0.25 g every 6 hours, is used to treat antibiotic-associated enterocolitis caused by Clostridium difficile. However, because of the emergence of vancomycin-resistant enterococci and the strong selective pressure of oral vancomycin for these resistant organisms, metronidazole is strongly preferred as initial therapy and vancomycin should be reserved for treatment of refractory cases. 

Daptomycin has proven efficacy in a number of in vivo animal models, including soft tissue infections by MRSA, bacteraemia caused by S. aureus or vancomycin-resistant enterococci (VRE), Enterococcus faecalis pyelonephritis, MRSA osteomyelitis, MRSA and Bacillus anthracis pulmonary infections, Gram-positive endocarditis, Clostridium difficile colitis and S. pneumoniae and S. aureus meningitis.9,64 66... 

Clostridium difficile is a commensal Gram-positive anaerobic bacterium of the human intestine, found in about 2-5% of the population. C. difficile is the most serious cause of antibiotic-associated diarrhoea and can lead to pseudomembranous colitis, a severe infection of the colon, often resulting from eradication of the normal gut flora by antibiotics. Discontinuation of causative antibiotic treatment is often curative. In more serious cases, oral administration of metronidazole or vancomycin is the treatment of choice. The bacterium produces several known toxins, including enterotoxin (toxin A) and cytotoxin (toxin B), both of which are responsible for the diarrhoea and inflammation seen in infected patients another toxin, binary toxin, has also been described. 

Clostridium difSaie Oral melronidazole Oral vancomycin Gram-native bacilli... 

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