Turki AlhaloolMD ,PEC /HMC

Third QPEM Conference January 11-13, 2019

Vancomycin or Clindamycin?

I do not have any relevant financial relationship with commercial interest to disclose.

DISCLOSURE

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At the end of the presentation, the attendee will be able to:

Learning Objectives

Discuss the antimicrobial resistance to Vancomycin & Clinda.

Rational the use of Vancomycin and Clindamycin

Learning Objectives

Antimicrobial Resistance

Antimicrobial Resistance continue..

Vancomycin

§Bactericidal glycopeptide antibiotic

§First used clinically in 1958

§Treat infections caused by Gram –Positive organisms like MRSA and amoxicillin resistant Enterococcus species

§ Inhibits bacterial cell wall synthesis

Parenteral§MRSA or beta- lactam resistant CA -ve Staph§Serious/ life-threatening allergic to penicillin/ cephalosporin§Empiric therapy central lines, VP , hemodialysis , grafts , prosthetic valves § Prophylaxis for PD catheters :

-invasive GIT procedure-touch contamination

§Treatment of peritonitis in patients with PD cath

Oral

§Clostridioides difficileinfection

§Enterocolitis caused by Staph A

Vancomycin Use

Dosing: < 60 mg/kg/dayis not enough

Vancomycin continue..

Vancomycin continue..

e

§Adverse ReactionsØ hypotension, neutropenia, flushing (red man syndrome),

DRESS syndrome, ototoxicity, renal failure

§PrecautionsØExtravasation & phlebitisØDisease related concernØAppropriate use

Clindamycin

§ Advantages :Ø Achieves high intracellular levels in phagocytic

cellsØ High levels in boneØ Reduce toxin production

§Lincosamide FDA approved for the treatment of anaerobes, strept and staph infections

Clindamycin continue..

Mechanism of action

§ Bacteriostatic and bactericidal against some strains of staph, strept and anaerobes (Bacteroides fragilis)

§ Killing activity :concentration, bacterial species & inoculum

§ Inhibits production of staph toxin associated with TSS

§ Inhibits alpha toxin expression in S. aureus

§RTI, skin & soft tissue and female pelvis &genital

§Sepsis and intra-abdominal infections

§Treatment of peritonitis for patients with PD catheters

§Treatment of babesiosis and malaria

§Prophylaxis : endocarditis, preoperative, and peritonitis in patients with PD catheters

Clindamycin Use

Clindamycin continue..

§The commonest adverse effects are diarrhea and allergic reactions.

§There is increasing resistance through modification of the target, inactivation of the drug or efflux of the drug

§Use with caution in patient receiving neuromuscular blocking drugs

§ Do not use in combination with macrolids and chloramphenicol

Vancomycin vs Clindamycin Character Vancomycin Clindamycin

Category Glycopeptide Lincosamide

Mechanism of action Bactericidal, inhibit cell wall synthesis

Bacterioststic, inhibit toxin production

Uses MRSA severe infectionsClostridioides difficile

Bone ,skin and soft tissue infections

Advantages No or low resistance High levels in the boneReduce toxin production

Adverse reactions Red man syndrome Antibiotic associated diarrhea

Take home messages

Increasing antibiotic resistance warranting proper selection to ensure adequacy of treatment

Vancomycin still the drug of choice for severe infections of MRSA and MSSA

Clindamycin has adventages of good penetration for local infections and toxin production inhibition

References

• Up to date• PubMed• Annual Antibiogram Report 2017, Microbiology Division/ HMC• O Neill J. December 2014• American society for Microbiology, December 2015