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Turki AlhaloolMD ,PEC /HMC
Third QPEM Conference January 11-13, 2019
Vancomycin or Clindamycin?
I do not have any relevant financial relationship with commercial interest to disclose.
DISCLOSURE
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At the end of the presentation, the attendee will be able to:
Learning Objectives
Discuss the antimicrobial resistance to Vancomycin & Clinda.
Rational the use of Vancomycin and Clindamycin
Learning Objectives
Antimicrobial Resistance
Antimicrobial Resistance continue..
Vancomycin
§Bactericidal glycopeptide antibiotic
§First used clinically in 1958
§Treat infections caused by Gram –Positive organisms like MRSA and amoxicillin resistant Enterococcus species
§ Inhibits bacterial cell wall synthesis
Parenteral§MRSA or beta- lactam resistant CA -ve Staph§Serious/ life-threatening allergic to penicillin/ cephalosporin§Empiric therapy central lines, VP , hemodialysis , grafts , prosthetic valves § Prophylaxis for PD catheters :
-invasive GIT procedure-touch contamination
§Treatment of peritonitis in patients with PD cath
Oral
§Clostridioides difficileinfection
§Enterocolitis caused by Staph A
Vancomycin Use
Dosing: < 60 mg/kg/dayis not enough
Vancomycin continue..
Vancomycin continue..
e
§Adverse ReactionsØ hypotension, neutropenia, flushing (red man syndrome),
DRESS syndrome, ototoxicity, renal failure
§PrecautionsØExtravasation & phlebitisØDisease related concernØAppropriate use
Clindamycin
§ Advantages :Ø Achieves high intracellular levels in phagocytic
cellsØ High levels in boneØ Reduce toxin production
§Lincosamide FDA approved for the treatment of anaerobes, strept and staph infections
Clindamycin continue..
Mechanism of action
§ Bacteriostatic and bactericidal against some strains of staph, strept and anaerobes (Bacteroides fragilis)
§ Killing activity :concentration, bacterial species & inoculum
§ Inhibits production of staph toxin associated with TSS
§ Inhibits alpha toxin expression in S. aureus
§RTI, skin & soft tissue and female pelvis &genital
§Sepsis and intra-abdominal infections
§Treatment of peritonitis for patients with PD catheters
§Treatment of babesiosis and malaria
§Prophylaxis : endocarditis, preoperative, and peritonitis in patients with PD catheters
Clindamycin Use
Clindamycin continue..
§The commonest adverse effects are diarrhea and allergic reactions.
§There is increasing resistance through modification of the target, inactivation of the drug or efflux of the drug
§Use with caution in patient receiving neuromuscular blocking drugs
§ Do not use in combination with macrolids and chloramphenicol
Vancomycin vs Clindamycin Character Vancomycin Clindamycin
Category Glycopeptide Lincosamide
Mechanism of action Bactericidal, inhibit cell wall synthesis
Bacterioststic, inhibit toxin production
Uses MRSA severe infectionsClostridioides difficile
Bone ,skin and soft tissue infections
Advantages No or low resistance High levels in the boneReduce toxin production
Adverse reactions Red man syndrome Antibiotic associated diarrhea
Take home messages
Increasing antibiotic resistance warranting proper selection to ensure adequacy of treatment
Vancomycin still the drug of choice for severe infections of MRSA and MSSA
Clindamycin has adventages of good penetration for local infections and toxin production inhibition
References
• Up to date• PubMed• Annual Antibiogram Report 2017, Microbiology Division/ HMC• O Neill J. December 2014• American society for Microbiology, December 2015
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