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Glycopeptides

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Fundamentals of Antimicrobial Pharmacokinetics and Pharmacodynamics

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Abstract

Glycopeptides are a class of antibiotic drugs that is composed of glycosylated cyclic or polycyclic nonribosomal peptides. Older molecules used in clinical practice are vancomycin and teicoplanin. Oritavancin, dalbavancin, and telavancin belong to the subclass of lipoglycopeptides. Glycopeptides inhibit bacterial cell wall peptoglycan synthesis of aerobic and anaerobic Gram-positive bacteria. Glyco (lipo)peptides are not absorbed orally and have to be administered intravenously. In this chapter, the pharmacokinetics (Pk) and the pharmacodynamics (Pd) of the glycopeptides are studied. Pk in serum as well as protein binding and elimination are reviewed. Pharmacodynamic data include MICs of Gram-positive bacteria, PK/Pd effects in in vitro systems, animal models and human studies. Adverse effects of glycopeptides on the host are concentration related nephro- and ototoxicity. In the past, because of fear of toxicity, the older glycopeptides have been underdosed in many settings. The implementation of Pk/Pd knowledge into clinical practice by e.g. administering higher doses of vancomycin and teicoplanin and using continuous infusion of vancomycin is urgently needed. This chapter contains clinical vignettes showing the benefit of Therapeutic Drug Monitoring of glycopeptides.

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Authors and Affiliations

  1. Nijmegen Institute for Infection, Infl ammation, and Immunity and Department of Medicine, Radboud University Medical Center, Nijmegen, The Netherlands

    Inge C. Gyssens M.D., Ph.D.

  2. Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands

    Inge C. Gyssens M.D., Ph.D.

  3. Hasselt University, Hasselt, Belgium

    Inge C. Gyssens M.D., Ph.D.

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Correspondence to Inge C. Gyssens M.D., Ph.D. .

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  1. Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Alexander A. Vinks

  2. Dept. Pharmaceutics, University of Florida, Gainesville College of Pharmacy, Gainesville, Florida, USA

    Hartmut Derendorf

  3. Dept. of Medical Microbiology, Radboudumc, Radboud University Nijmegen, Nijmegen, The Netherlands

    Johan W. Mouton

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Gyssens, I.C. (2014). Glycopeptides. In: Vinks, A., Derendorf, H., Mouton, J. (eds) Fundamentals of Antimicrobial Pharmacokinetics and Pharmacodynamics. Springer, New York, NY. https://doi.org/10.1007/978-0-387-75613-4_12

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