Inhibits bacterial growth by preventing cross-linking of the peptidoglycan component in the cell wall of Gram positive organisms.

Bactericidal and prevents polymerization by binding D-alanine-D-alanine moiety of cell wall precursors and prevents the addition of murien units to the growing polymer chain.

Many gram-positive organism associated with neutropenic fever such as coagulase negative staphylococci, Corynebacterium spp., MRSA and vancomycin-resistant enterococci, and viridans are resistant to antimicrobacterial agents frequently used for prophylaxis and empiric treatment.

Is the guideline recommended as first line antibiotic for invasive MRSA infections.

While vancomycin has been used empirically in neutropenic fever it has not been shown to improve responses in regimens that do not contain vancomycin ((Rubin M, Cometta A, Feld R).

Risk of renal toxicity increases with dose and duration of treatment.

Increased renal toxicity associated with increased body weight and impaired creatinine clearance.

Disadvantages include: nephrotoxicity, need for monitoring trough serm levels and relatively poor pharmacokinetics.

Nephrotoxicity associated with elevated serum levels.

Associated with a high frequency of an allergic reaction to histamine release from mast cells: The red man syndrome.
The red man syndrome is more common in white patients than black and is more frequently documented in males than in females.

Remains the first line treatment for many bone and joint infections.

Acquisition of an enzyme that alters D-alanine precursors to D-alanine-D-lactate precursors initiates resistance.

Increased use associated with increased resistance to enterocci.

Declining bactericidal activity and vancomycin susceptibilities among gram-positive organisms due to tolerance or polymorphism at the aqccessory gene locator locus (Safdar A, Sakoulas G, Moise-Broder PA, Sorlano, A).

Efficacious against all gram positive organisms, but is reserved for multiresistant bacteria.

Utilized orally for pseudomonas colitis caused by C. difficile, along with metronidazole.

Less effective than linezolid for treatment of soft tissue infections.

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