Table of Contents
Teicoplanin and vancomycin: clinical indications and usefullness of drug monitoring
Teicoplanine et vancomycin… what are we going to tell you ?
Mode of action : inhibition of bacterial cell wall synthesis upstream to ? lactams
Binding of vancomycin to D-Ala-D-Ala
Relationship between the use of vancomycin and the development of resistance in enteroccci in U.S.A.
Resistance to glycopeptides in Europe ...
Why different levels in North America and Europe ?
Resistance to vancomycin in enterococci (VRE) and staphylocci (GISA): the real issues...
Glycopeptides appropriate uses
Vancomycin in S. Aureus endocarditis (Levine, Ann Intern Med 1991)
Meta-analysis of combined results (Wood, JAC 1996)
Reported nephrotoxicity (Wood, JAC 1996)
Comparative efficacy and safety of teicoplanin and vancomycin Wood, JAC 1996)
Glycopeptides inappropriate uses (1/2)
Glycopeptides inappropriate uses (2/2)
Can pharmacokinetics/pharmacodynamics help in optimizing glycopeptide treatments ?
Glycopeptides PK/PD: which is the important parameter ?
Area under the curve (AUC)
AUC / MIC ratio
AUC vs peak and trough
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Glycopeptides dosing recommendations at the Cliniques Saint-Luc
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Total cumulative doses of vancomycin based either on the initial dose regimen extrapolated to the duration of treatment (median 21d) or on the dose adjusted by TDM-PK (Clin. Univ. St Luc)
Monitoring and prevention of toxicity: effect of age on vancomycin nephrotoxicity risk (1/2)
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Vancomycin Outcomes vs MIC and AUC/MICs
Vancomycin 1g every 12h (normal adult) PK/PD parameters for 1g every 12h
24h-AUC/MIC and Resistance
Vancomycin “time to eradication” in MRSA Infections
Why is vancomycin so weak vs MRSA?
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Vancomycin /Teicoplanin PK/PD parameters taking into account protein binding
Clinical outcome / teicoplanin predose concentration Mc Gouwan, J Inf Chemother 1996-1998 Harding, JAC 2000 Wilson , IJAA 1994)
Teicoplanin recommanded levels
Conclusions (1/3) ...
Conclusions (2/3) ...
Conclusions (3/3) ...
Thank you ...
But do not forget ...
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Author: Paul M. Tulkens
Home Page: http://www.md.ucl.ac.be/seminfect/resume.htm
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