Select a medication used in evidence-based treatment guidelines for the condition chosen in the first discussion question. Share the mechanism of action of this medication and hints for monitoring, side effects, and drug interactions of which one should be aware

Select a medication used in evidence-based treatment guidelines for the condition chosen in the first discussion question. Share the mechanism of action of this medication and hints for monitoring, side effects, and drug interactions of which one should be aware

Select a medication used in evidence-based treatment guidelines for the condition chosen in the first discussion question. Share the mechanism of action of this medication and hints for monitoring, side effects, and drug interactions of which one should be aware

Vancomycin

Vancomycin is a glycopeptide antibacterial drug of the class of cell wall synthesis inhibitors. Vancomycin is commonly used in the management of resistant gram-positive infections. The purpose of this paper is to discuss the mechanism of action, monitoring, side effects, and interactions of Vancomycin.

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Mode of Action

Vancomycin acts through binding to the Acyl-D-Ala-D-Ala moiety of the peptidoglycan cell layer. It prevents the incorporation of N-acetylmuramic Acid and N-Acetylglucosamine into the cell wall (Shivali Patel et al., 2019). These crosslinks are vital in maintaining the integrity of the cell wall. This binding inhibits the enzyme transpeptidase which is responsible for the elongation and crosslinking of the peptidoglycans resulting in reduced crosslinks in the cell wall. Vancomycin also acts to alter the permeability of the bacterial cell membrane and disrupt the bacterial Ribonucleic Acid. Vancomycin is bactericidal. Vancomycin is effective against Gram-positive bacteria.

Hints for monitoring Vancomycin

Monitoring Vancomycin levels in the blood is important in preventing toxicity. This is particularly an important aspect in geriatric patients, morbid obesity, critically ill patients, and when they are used together with drugs that are toxic to the kidneys (Tsutsuura et al., 2021). Monitoring is through regular checks on the renal function tests and complete blood count. In stable patients, monitoring plays a role in the assessment of an ideal response to treatment.

Side Effects

The adverse effects of Vancomycin use include anaphylactic hypersensitivity reaction and toxicity to the kidneys. The rapid infusion of intravenous vancomycin causes the Redman syndrome characterized by flushing, rash on the face and torso, and massive pruritus. Other side effects include neutropenia, angioedema, hypotension, and Steven Johnson Syndrome which is rare.

Drug Interactions

Vancomycin interacts with a myriad of drugs which affect its excretion and metabolism. Drugs that decrease the excretion of Vancomycin include Antivirals such as Acyclovir, Antiretrovirals such as Abacavir and Adefovir, and NSAIDs such as Aceclofenac, Acetylsalicylic Acid, and diclofenac (Wang et al., 2018). These drugs increase the serum concentration of vancomycin. Drugs that increase the excretion of Vancomycin include diuretics such as acetazolamide and amiloride. These drugs decrease the serum concentration of vancomycin. Vancomycin is principally excreted through the kidneys. Any drug that lowers the GFR affects the excretion of vancomycin. When used together with nephrotoxic drugs such as Alendronic Acid increase the severity of kidney damage. Vancomycin has also displayed severe interactions with the cholera vaccine, BCG, and typhoid vaccines.

Conclusion

Vancomycin is an antibiotic that has proved vital in the management of several resistant infections. Monitoring is important during its use to reduce the occurrence of adverse effects. Before co-administration of Vancomycin with other drugs, it is crucial to ascertain any drug interactions as Vancomycin interacts with over eighty drugs.

References

Shivali Patel, Preuss, C. V., & Bernice, F. (2019, October 29). Vancomycin. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459263/

Tsutsuura, M., Moriyama, H., Kojima, N., Mizukami, Y., Tashiro, S., Osa, S., Enoki, Y., Taguchi, K., Oda, K., Fujii, S., Takahashi, Y., Hamada, Y., Kimura, T., Takesue, Y., & Matsumoto, K. (2021). The monitoring of vancomycin: a systematic review and meta-analyses of area under the concentration-time curve-guided dosing and trough-guided dosing. BMC Infectious Diseases, 21(1). https://doi.org/10.1186/s12879-021-05858-6

Wang, F., Zhou, H., Olademehin, O. P., Kim, S. J., & Tao, P. (2018). Insights into Key Interactions between Vancomycin and Bacterial Cell Wall Structures. ACS Omega, 3(1), 37–45. https://doi.org/10.1021/acsomega.7b01483

Select a medication used in evidence-based treatment guidelines for the condition chosen in the first discussion question. Share the mechanism of action of this medication and hints for monitoring, side effects, and drug interactions of which one should be aware.