Glycopeptides (Vancomycin and Teicoplanin) and Lipoglycopeptides (Telavancin, Oritavancin, and Dalbavancin)

Vancomycin remains one of the most frequently used antibiotics in the hospital setting, particularly for severe skin infections, osteomyelitis, and also for bacteremia and endocarditis caused by methicillin-resistant Staphylococcus aureus (MRSA). It is often used for MRSA pneumonia and as an alternative for enterococcal and streptococcal endocarditis. Oral vancomycin is useful for Clostridioides difficile (formerly Clostridium difficile) colitis. For serious MRSA infections, a loading dose is recommended; current guidelines suggest a target for AUC/MIC ratio above 400, but optimal dosing and monitoring for efficacy and avoidance of toxicity are still being debated. Common side effect includes nephrotoxicity, which increases with higher serum levels and duration of therapy, and the red neck syndrome. The in vitro activity of teicoplanin overlaps with that of vancomycin. A loading dose should be given, higher doses are needed for severe MRSA infections, and the most common side effects are rash and drug-related fever. Teicoplanin could be considered for enterococcal infections or for outpatient treatment of certain MRSA infections. Lipoglycopeptides telavancin, dalbavancin, and oritavancin are semisynthetic derivatives of glycopeptides with in vitro activity against staphylococci, streptococci, and enterococci and, in the case of oritavancin, also vancomycin-resistant enterococci. These agents are approved for acute bacterial skin and skin structure infections (ABSSSI) due to various gram-positive bacteria, and telavancin is also approved as an alternative for S. aureus hospital-acquired and ventilator-associated pneumonia. Telavancin is given once daily, and its main side effect is renal impairment; the long terminal half-life of dalbavancin and oritavancin allows one-time dosing for ABSSSI.