[Vancomycin in 1991: current status and perspectives].

Vancomycin is a narrow-spectrum glycopeptide antibiotic which is primarily active against Gram-positive organisms. Bacterial resistance develops rarely due to its numerous modes of action. The mode of action of vancomycin involves the inhibition of peptidoglycan synthesis. Vancomycin forms a stoichiometric complex with the peptidoglycan precursor UDP-N-acetylmuramyl pentapeptide by forming hydrogen bonds. In patients with renal insufficiency vancomycin clearance is reduced and elimination half-life prolonged. Vancomycin is the drug of choice in the treatment of methicillin-resistant staphylococcal infections and in the treatment of Gram-positive endocarditis and has been used as alternative therapy in the treatment or prophylaxis of Gram-positive infections in penicillin-allergic patients.