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chapter 7 Glycopeptides 95
was brown, and clinicians trying to amuse
themselves dubbed it “Mississippi mud.” The
current formulation is clear and lacks those
potentially toxic excipients. Telavancin has
renal toxicity issues as well.
Telavancin: In addition to the above reactions,
taste disturbances and foamy urine occur with
telavancin. Telavancin should not be given to
pregnant women because of problems seen in
animal studies.
Dosing Issues
Vancomycin is often pharmacokinetically monitored.
Trough concentrations can be used to ensure
that the drug is not being eliminated too quickly
or slowly, and different indications have different
preferred trough ranges. Recent data indicate
that higher troughs may be associated with
nephrotoxicity. Peak concentrations are only useful
for calculating patient-specific pharmacokinetic
parameters. They do not seem to predict efficacy or
safety and should not be drawn for most patients.
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Important Facts
• Oral vancomycin is absorbed very poorly. Its
only use is for the treatment of Clostridium
difficile–associated disease. Also, IV vancomycin
does not reach intracolonic concentrations
high enough to kill C. difficile, so oral is the
only way to go.
• Do not overreact if your vancomycin trough is
too high. Was it drawn correctly? If so, increase
your dosing interval.
• Although vancomycin is active against staphylococci,
it does not kill MSSA as quickly