Glycopeptides and Endocarditis
Glycopeptides are used as an alternative to β-lactams for patients with hypersensitivity to penicillin or who are infected with resistant bacteria. Glycopeptides are only slowly bactericidal, if at all, so must always be used in combination with another agent. Vancomycin is currently the glycopeptide of choice and in patients with normal renal function 1 g every 12 h should be used initially. Dosage can then be modified according to trough level, normally 10–15 mg/L, but increasing to 15–20 mg/L for staphylococcal isolates with an MIC ≥2 mg/L. Teicoplanin may be considered for streptococcal endocarditis but at an initial dosage of at least 10 mg/kg every 12 h, then 10 mg/kg per day. As pharmacokinetics are unpredictable, levels must be measured at least weekly to ensure trough levels of at least 20 mg/L.
The role of the newer long-acting glycopeptides in the treatment of endocarditis has yet to be determined.
