[Oxazolidinones and glycopeptides].
We review the chemical structure, pharmacokinetics, antimicrobial spectrum, mechanisms of action and resistance, clinical use and adverse effects of oxazolidinones (linezolid) and glycopeptides. Oxazolidinones inhibit protein synthesis and glycopeptides cell wall synthesis. Antibacterial spectra cover grampositive pathogens, including multiresistant organisms. Linezolid has a 100% absorption and can be administered orally or intravenously; it is cleared by renal and hepatic routes, thus dose adjustments are not needed in moderate renal or hepatic failure. Oral absorption of glycopeptides is minimal. They are excreted by the kidneys (dose adjustments are needed in renal failure). The main clinical indications are the treatment of infections caused by grampositive pathogens; linezolid is also useful for infections caused by glycopeptide-resistant enterococcal infections. Linezolid can cause trombocytopenia when treatment lasted longer than two weeks. The main side effect of vancomycin is its nefrotoxicity and teicoplanin can cause fever.
Pigrau
Carlos
C
Servicio de Enfermedades Infecciosas. Hospital Universitario Vall Hebron. Barcelona. España. pigrau@hg.vhebron.es
D000081:Acetamides / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000009:adverse effects / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use; D001711:Biotransformation; D002473:Cell Wall / Q000187:drug effects*; D024901:Drug Resistance, Multiple, Bacterial; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy*; D006636:Histamine Release / Q000187:drug effects; D006801:Humans; D000069349:Linezolid; D015394:Molecular Structure; D023303:Oxazolidinones / Q000009:adverse effects / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use; D010457:Peptidoglycan / Q000096:biosynthesis; D018410:Pneumonia, Bacterial / Q000188:drug therapy; D011500:Protein Synthesis Inhibitors / Q000009:adverse effects / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000188:drug therapy; D017334:Teicoplanin / Q000627:therapeutic use; D014640:Vancomycin / Q000627:therapeutic use
D000081:Acetamides; D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D023303:Oxazolidinones; D010457:Peptidoglycan; D011500:Protein Synthesis Inhibitors; D017334:Teicoplanin; D014640:Vancomycin; D000069349:Linezolid