antibioticsbooks

Glycopeptides
7
Agents: vancomycin, telavancin
To date, three glycopeptides are in clinical use: vancomycin,
teicoplanin, and telavancin. Teicoplanin
is not used in the United States, and telavancin
was only recently approved. At least two more
glycopeptides are in late stages of clinical development:
oritavancin and dalbavancin.
Vancomycin is invaluable, because it has
activity against all things Gram-positive that
have not learned to become resistant to it. Many
enterococci (especially E. faecium) have figured
this out—we call them vancomycin-resistant
enterococci (VRE). A few staphylococci have
learned vancomycin-resistance from the enterococci,
but these staphylococci are currently very
rare. In general, they are susceptible.
Telavancin is a somewhat different agent. It is
a lipoglycopeptide that was modified from vancomycin’s
structure. It has some unique properties
that may be advantageous compared with vancomycin,
such as improved activity against MRSA
that is less susceptible to vancomycin, but its place
in therapy is still being determined.