URDANETA CITY College of Pharmacy

UNIVERSITY
Owned and operated by the City Government of Urdaneta

ANTIBIOTICS
IV. MISCELLANEOUS ANTIBIOTICS
A. GLYCOPEPTIDES
- Most powerful antibiotics
- Very nephrotoxic
- Lack systemic activity following oral administration
- Source: Bacillus and Streptomyces spp
- Interferes with the bacterial cell wall synthesis and disrupt cell membrane integrity and mostly
are only effective against gram positive bacteria.

1. Vancomycin
- Isolated from Streptomyces orientalis (new: Amycolopsis orientalis)
- Always administered via slow IV injection or IV infusion

 Mechanism of action
- inhibits D- ala- D- ala terminal of cell wall inhibiting transglycorylation preventing elongation
leading to inhibition of forming peptidogylcan

 Spectrum of activity
- Active against most gram positive cocci and bacilli including almost all S. aureus and coagulase
negative staphylococcal strains that are resistant to penicillins and cephalosporins
- Active against many strains of Enterococci mostly E. faecalis
- Used for serious infection and endocarditis caused by MRSA, beta lactam resistant and multidrug
resistant S. pneumoniae, Enterococcus when beta lactams cannot be used because of drug allergy
or resistance

 Untoward effects
- Hypersensitivity reaction
- Red neck syndrome: histamine mediated reaction than can cause pruritus and flushing on the
face, neck and shoulders that’s why it should be infused over greater than or equal to 60 minutes
- Neutropenia and thrombocytopenia
- Nephrotoxicity
- Dose related ototoxicity

2. Teicoplanin
- Isolated from Actinoplanes teichomyceticus
- Similar mechanism of action and activity with Vancomycin
- Given IV/ IM bec it is not absorbed orally
- Used in the treatment of osteomyelitis and endocarditis
- ADRs: skin rash, hypersensitivity reactions, drug fever, neutropenia
- According to Indian Institute of Technology, Teicoplanin is a potential therapeutic option against
COVID- 19 and can be 10 times more effective than several drugs being currently used such as
Lopinavir and Hydroxychloroquine

3. Telavancin
- Semi- synthetic lipoglycopeptide similar to vancomycin
- Has 2 MOAs: first is the same with vancomycin and the 2nd is that they disrupt the cell membrane
potential which increases membrane permeability

Compiled by:
Maricar Grace F. Mararac, RPh
 URDANETA CITY College of Pharmacy
UNIVERSITY
Owned and operated by the City Government of Urdaneta

- Used for complicated skin and skin structure infections as well as for hospital acquired and
ventilator acquired pneumonia caused by sensitive isolates of S. aureus

4. Dalbavancin
- Same as teicoplanin
- Indicated for acute bacterial skin and skin structure infections (ABSSSI) caused by gram positive
bacteria

5. Oritavancin
- Active against vancomycin resistant enterococci (VRE) strains that harbour the vanA gene

6. Bacitracin
- Isolated from Bacillus subtilis from the debrided wound of a 7 yr old Margaret Tracy
- Inhibits cell wall synthesis and is active against gram positive bacteria
- Used mainly as a topical treatment for superficial skin infections caused S. aureus

7. Polymyxins (Polymyxin B and Polymyxin E: Colistin)

- Polymyxin B: isolated from Bacillus polymyxa and Bacillus aeroporous
- Polymyxin E or Colistin: isolated from Bacillus colistinus. Colistin sulphate is used for oral use and
as Colistin methane sulfonate/ Colistinmethate sodium for parenteral administration
- Cationic polypeptide antibiotics that attach to and disrupt the cell membranes by binding to the
anionic outer membrane and thereby neutralizing the bacteria’s toxicity and causing bacterial cell
death. They also bind and inactivate endotoxin.
- Active against most facultative and aerobic gram negative bacilli, including P. aeruginosa and
Acinetobacter spp
- Should not be given simultaneously with drugs that block neuromuscular transmission such as
Rocuronium or are nephrotoxic drugs such as aminoglycosides
- Block neuromuscular transmission: both can cause circumoral and extremity paresthesias,
vertigo, slurred speech and muscle weakness and respiratory difficulty due to neuromuscular
blockade esp in patients with renal insufficiency.
- ADRs: nephrotoxicity and central and peripheral neurotoxicity

B. Metronidazole
- Bactericidal antibiotic that enters the bacterial cell wall and disrupts DNA and inhibits DNA
synthesis in certain microorganisms.
- Active against all obligate anerobic bacteria and certain protozoan parasites
- DOC for bacterial vaginosis
- Treatment and prevention of relapses of peptic ulcers due to H. pylori but in combination with
other drugs (quadruple and triple therapy)
- ADR: Disulfiram like reaction; if alcohol is ingested within 7 days of use. Includes flushing,
headache, nausea and vomiting)

Compiled by:
Maricar Grace F. Mararac, RPh