Antibiotics - Glycopeptides: Nursing pharmacology

Glycopeptides are antibiotics primarily used to treat skin infections such as erysipelas, cellulitis, wound infections, and skin abscesses caused by gram-positive bacteria.

Additionally, some glycopeptides can be used to treat staphylococcal enterocolitis, gastrointestinal Clostridioides difficile infection, joint or bone infections, and other serious infections like pneumonia, endocarditis, bacteriemia, and septicemia.

Glycopeptides work well against Staphylococcus epidermidis, Staphylococcus agalactiae, Staphylococcus aureus, especially the methicillin-resistant type called MRSA, as well as Streptococcus pneumoniae, Streptococcus pyogenes, and vancomycin susceptible Enterococcus faecalis.

There are four medications in this group: vancomycin, telavancin, dalbavancin, and oritavancin. All glycopeptides are administered intravenously, while vancomycin can also be given orally.

Once administered, glycopeptides inhibit bacterial cell wall synthesis by interfering with peptidoglycan polymerization and cross-linking, ultimately causing bacterial cell death.Common side effects of glycopeptides include ototoxicity, injection site reactions, and gastrointestinal disturbances like nausea, vomiting, and diarrhea.

In some cases, glycopeptides can disrupt the healthy intestinal flora and allow resistant bacteria to overgrow, which may result in superinfection, such as Clostridioides difficile infection or CDI for short.

For treatment, CDI and staphylococcal enterocolitis are the only indications for oral vancomycin. Some glycopeptides can also cause side effects like prolonged QT interval, arrhythmias, and peripheral edema.

Clients taking glycopeptides can also develop anaphylactic reactions. Other serious side effects include nephrotoxicity, which is a boxed warning for telavancin!

Some clients taking glycopeptides may also develop hematologic side effects like leukopenia and eosinophilia; while vancomycin can also cause immune thrombocytopenia and neutropenia.

Also, if given too rapidly, vancomycin can cause a reaction called vancomycin flushing syndrome, previously known as red man syndrome, which presents as flushing, sweating, rash, urticaria, and hypotension.

Finally, vancomycin and telavancin have a boxed warning for causing embryonic and fetal toxicity. Glycopeptides should be used with caution during pregnancy and breastfeeding, as well as in neonates and elderly clients.

Precaution should also be taken in clients with hearing loss; as well as in those with renal disease or who are receiving other nephrotoxic medications.

In particular, telavancin comes with a boxed warning for use in clients with renal disease.Regarding interactions, glycopeptides should not be used with any medication that is known to prolong the QT interval, such as quinidines or amiodarone, as this can cause arrhythmias.

In addition, glycopeptides shouldn’t be combined with other nephrotoxic and ototoxic medications, such as furosemide, aminoglycosides, colistin, and cisplatin.

Also dimenhydrinate should be avoided when using glycopeptides, as it can mask the symptoms of ototoxicity. More specifically, NSAIDs can increase the levels of vancomycin, potentially causing toxicity.

Finally, unfractionated heparin is contraindicated for 120 hours after administering oritavancin, as it can falsely elevate the aPTT for up to 120 hours.Okay, now when a client is prescribed an intravenous glycopeptide like vancomycin to treat an MRSA infected incision, first perform a baseline assessment, including weight, vital signs, and examine the incision site for redness, drainage amount and type, or localized edema.

Then, review your client’s most recent laboratory test results, including CBC, renal function tests, and wound culture and sensitivity tests; and confirm a negative pregnancy test as appropriate.

Lastly, check that the prescribed dosage is correct by calculating mg/kg.Then, explain to your client that the medication will help eliminate the bacteria infecting their wound.

Let them know you’ll be infusing the medication slowly over 1 hour, and that you will be checking on them regularly during the infusion.

Also inform them that you’ll be drawing blood at prescribed intervals in order to measure the amount of vancomycin in their blood.

Then, instruct your client to let you know if they feel any pain or discomfort at the infusion site during the infusion, as well as ringing in the ears or dizziness; flushing; or itching.

Now, before starting the infusion, ensure your client has a patent peripheral IV and that an indwelling urinary catheter is in place.

During the infusion, monitor your client closely for signs of a vancomycin flushing syndrome, such as flushing of the neck, face, and upper body.

If this happens, slow the infusion rate and notify the healthcare provider right away. Monitor for signs of CDI, which could manifest as abdominal pain and the presence of loose, watery, or bloody stools.

Be sure to notify the healthcare provider if this occurs, and send a stool sample to the lab for testing. In addition, keep a close eye on your client’s renal function by monitoring their renal function tests, fluid intake and output, and watching for signs like hematuria or edema.

Lastly, ensure effective serum trough levels by obtaining blood samples per facility protocol. Finally, when caring for a client receiving vancomycin intravenously, be sure to monitor them closely for laboratory values, side effects, and assess their incision site throughout therapy, while also evaluating for the desired therapeutic response of infection resolution.

All right, as a quick recap… Glycopeptides are antibiotics used to treat a number of infections like those caused by Staphylococcus, including MRSA.

These medications can be given orally or intravenously, and work by inhibiting bacterial cell wall synthesis, ultimately causing bacterial cell death.

Side effects include gastrointestinal disturbances, injection site reactions, ototoxicity, and nephrotoxicity. When caring for a client prescribed a glycopeptide, nursing considerations include performing a baseline assessment, as well as close monitoring of laboratory values, side effects, assessing the incision site, and evaluating for the desired therapeutic response.

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