Cheung R P, DiPiro J T
Pharmacotherapy. 1986 Jul-Aug;6(4):153-69. doi: 10.1002/j.1875-9114.1986.tb03471.x.
Vancomycin is a narrow-spectrum glycopeptide antibiotic with potent antistaphylococcal activity. It is primarily active against gram-positive organisms. Bacterial resistance rarely develops due to its numerous modes of action. The toxic potential of vancomycin is less significant than previously thought. "Red neck syndrome" seems to be the most common side effect and appears to be caused by rapid intravenous infusion. It is characterized by erythema at the base of the neck and the upper back; hypotensive episodes may also occur. Nephrotoxicity and ototoxicity are rare. Relationships between toxicities and serum concentrations have not been established. The disposition of vancomycin after intravenous administration proceeds biphasically--rapid distribution followed by elimination. The drug is excreted primarily unchanged in the urine by glomerular filtration. Vancomycin clearance is reduced and elimination half-life is prolonged in patients with renal insufficiency. Various methods have been published to aid in dosing the drug in these patients. Vancomycin is the drug of choice in the treatment of methicillin-resistant staphylococcal infections. It is also useful in the treatment of gram-positive endocarditis and has been used as alternative therapy in the treatment of prophylaxis of gram-positive infections in penicillin-allergic patients. Oral vancomycin is the preferred therapy in antibiotic-associated colitis.
万古霉素是一种窄谱糖肽类抗生素，具有强大的抗葡萄球菌活性。它主要对革兰氏阳性菌有活性。由于其多种作用方式，细菌很少产生耐药性。万古霉素的潜在毒性比以前认为的要小。“红颈综合征”似乎是最常见的副作用，似乎是由快速静脉输注引起的。其特征是颈部和上背部底部出现红斑；也可能发生低血压发作。肾毒性和耳毒性很少见。毒性与血清浓度之间的关系尚未确定。静脉给药后万古霉素的处置呈双相性——快速分布后消除。该药物主要通过肾小球滤过以原形经尿液排泄。肾功能不全患者的万古霉素清除率降低，消除半衰期延长。已经发表了各种方法来帮助这些患者给药。万古霉素是治疗耐甲氧西林葡萄球菌感染的首选药物。它也可用于治疗革兰氏阳性心内膜炎，并已被用作青霉素过敏患者预防革兰氏阳性感染的替代疗法。口服万古霉素是抗生素相关性结肠炎的首选治疗方法。
