Monobactams, Cyclic Lipopeptide and Polypeptide – Cell Wall Synthesis Inhibitors (Antibiotics)

by Pravin Shukle, MD

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    00:00 Let's talk about vancomycin.

    00:03 So vancomycin is kind of an interesting one.

    00:05 It binds to a bacterial glycoprotein on the alanine surface of the peptidoglycan.

    00:12 So we've kind of magnified the peptidoglycan here.

    00:16 It -- the resistant organisms to vancomycin have an altered terminal.

    00:22 So there's a decrease affinity for the vancomycin.

    00:25 In this case the vancomycin is the yellow little star shaped thing that you see there.

    00:31 We only use vancomycin for very serious infections.

    00:34 Now vancomycin despite the fact that we've magnified things, looks like a small molecule, it's actually quite a large molecule.

    00:41 And it does not cross the blood brain barrier.

    00:44 So if you have say a spinal infection or a brain infection, we administer it intrathecally.

    00:52 We use it orally however for luminal infections of the gut because it's not absorbed across the gut wall.

    00:58 So it stays inside the gut.

    01:00 And if you have an infection inside the gut, it's quite effective.

    01:04 The important toxicity that I want you to remember with vancomycin and that I guarantee you'll be tested on, is something called Red Man syndrome.

    01:12 This somewhat sexist term applies equally to men and women by the way.

    01:19 It causes severe cutaneous flushing from histamine release.

    01:22 So it's quite a dramatic and quite noticeable sort of reaction.

    01:28 And at first you think it's a type of horrible allergy.

    01:31 It's not quite an allergy in the same sense.

    01:33 It's actually an histamine release.

    01:35 It can also cause phlebitis, ototoxicty and nephrotoxicity.

    01:39 So this is a potentially toxic agent.

    01:44 Let's talk a little bit about bacitracin.

    01:46 It's not often covered in antibiotic lectures because we tend to forget about it.

    01:51 But it's used tremendously in hospitals.

    01:55 It's used as the topical treatment and decontamination treatment for things like methicillin resistant staphylococcus aureus.

    02:04 So you'll often see patients being treated with bacitracin in hospital.

    02:08 It's used in staphylococcus colonization of the skin.

    02:12 Now it can cause nephrotoxicity so it's not used orally or parenterally.

    02:18 We only use it topically for practical purposes.

    02:24 Daptomycin is a cyclic lipopeptide.

    02:27 It is for the treatment of vancomycin resistant enterococcus and vancomycin resistant staphylococcus aureus.

    02:34 You have to monitor creatinine levels very closely.

    02:38 Sorry CK levels very closely during treatment.

    02:41 And that's because daptomycin is very myopathic.

    02:46 And so it can cause severe muscle disease.

    About the Lecture

    The lecture Monobactams, Cyclic Lipopeptide and Polypeptide – Cell Wall Synthesis Inhibitors (Antibiotics) by Pravin Shukle, MD is from the course Antimicrobial Pharmacology. It contains the following chapters:

    • Vancomycin
    • Bacitracin
    • Daptomycin

    Included Quiz Questions

    1. It is markedly nephrotoxic when taken parenterally.
    2. Enzymes in the blood break it down before reaching its target.
    3. It causes severely elevated levels of creatinine kinase.
    4. It requires oxygen to be active as a bactericidal agent.
    5. It results in severe histamine release leading to “red man syndrome”.
    1. Vertigo
    2. Phlebitis
    3. Severe histamine release
    4. Nephrotoxicity
    5. Ototoxicity
    1. Intrathecally
    2. Intravenously
    3. Intramuscularly
    4. Rectally
    5. Orally
    1. Creatine kinase
    2. Creatinine and BUN
    3. White blood cell count
    4. Iron studies
    5. Transaminases

    Author of lecture Monobactams, Cyclic Lipopeptide and Polypeptide – Cell Wall Synthesis Inhibitors (Antibiotics)

     Pravin Shukle, MD

    Pravin Shukle, MD

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