さまよう薬剤師のブログ

学位を持っても、センスのない、感染制御専門薬剤師のブログ.  I have Ph.D. but less sense ID pharmacist.

VCM以外の抗MRSA抗VRE薬

MRSA復習週間

当院はVCMがほとんど
抗菌薬の採用整備中…

UpToDate より引用

様々な抗菌薬ありますね。
厳密な使い分けが、必要な時がいつ来るのか

DAPTOMYCIN
Daptomycin is a bactericidal cyclic lipopeptide with lipophilic tail that inserts itself into the bacterial membrane and forms a channel causing efflux of intracellular potassium, with subsequent depolarization of the cell membrane. Daptomycin administration has been associated with myopathy; weekly creatine phosphokinase monitoring should be performed for prolonged administration.

LINEZOLID
Linezolid is a bacteriostatic oxazolidinone that binds to the 50S subunit of the bacterial ribosome, inhibiting bacterial protein synthesis. Important adverse effects related to linezolid use include myelosuppression, optic neuropathy, peripheral neuropathy, lactic acidosis, and serotonin syndrome. Weekly complete blood count monitoring should be performed for prolonged administration.

CEFTAROLINE
Ceftaroline is a parenteral cephalosporin with activity against methicillin-resistant Staphylococcus aureus (MRSA). It is well-tolerated and approved for use in community-acquired pneumonia and for the treatment of complex skin and soft tissue infections, including MRSA.

TELAVANCIN
Telavancin is a synthetic lipoglycopeptide with in vitro activity against most gram-positive organisms. Clinical data support its use in select staphylococcal infections (specifically uncomplicated bacteremia, nosocomial pneumonia, and complicated skin and skin structure infections) but are lacking for use in vancomycin-resistant enterococci infection. Safety concerns include infusion-related reactions and nephrotoxicity.

DALBAVANCIN
Dalbavancin is a lipoglycopeptide approved for treatment of acute bacterial skin and skin structure infections caused by susceptible gram-positive pathogens (including methicillin-susceptible and methicillin-resistant S. aureus and streptococci). Dalbavancin is highly protein bound and has a terminal half-life of two weeks. Administration of dalbavancin is generally well tolerated. Side effects noted in clinical trials of acute bacterial skin and skin structure infections have been primarily gastrointestinal (nausea, diarrhea) and headache. 

ORITAVANCIN
Oritavancin is a lipoglycopeptide approved for treatment of acute bacterial skin and skin structure infections caused by susceptible gram-positive pathogens, including methicillin-susceptible and methicillin-resistant S. aureus and streptococci. Vancomycin-nonsusceptible enterococci are often susceptible to oritavancin. Adverse reactions may include gastrointestinal disturbances and headache. Use of heparin for 48 hours after oritavancin administration is contraindicated. A single intravenous dose is used in adult patients for the treatment of acute bacterial skin and skin structure infections. 

TEDIZOLID
Tedizolid is an oxazolidinone approved for the treatment of acute bacterial skin and skin structure infections caused by susceptible staphylococci, streptococci, and Enterococcus faecalis. Adverse effects are largely gastrointestinal. Tedizolid is a reversible inhibitor of monoamine oxidase in vitro. 

TIGECYCLINE
Tigecycline is a bacteriostatic glycylcycline active against gram-positive, gram-negative and anaerobic organisms; it is not active Pseudomonas or Proteus spp. The most common adverse drug effects are mild nausea and vomiting. The drug's boxed warning, added due to concerns of increased mortality in patients receiving the drug, significantly limits its use for the treatment of gram-positive infections. Its primary application is treatment of multidrug-resistant gram-negative pathogens.

QUINUPRISTIN-DALFOPRISTIN 
Quinupristin/dalfopristin is a bactericidal combination of two semisynthetic streptogramins. It must be infused through a central venous catheter due to risk of thrombophlebitis. It is associated with conjugated hyperbilirubinemia; liver function test monitoring should be performed. Use of quinupristin/dalfopristin (most notably for MRSA infections) has been largely supplanted by newer treatment options.