Vancomycin or Clindamycin?q-pem.com/wp-content/uploads/2019/04/2019-QPEM-PPT... · 2019-04-03 ·...
Transcript of Vancomycin or Clindamycin?q-pem.com/wp-content/uploads/2019/04/2019-QPEM-PPT... · 2019-04-03 ·...
![Page 1: Vancomycin or Clindamycin?q-pem.com/wp-content/uploads/2019/04/2019-QPEM-PPT... · 2019-04-03 · §Empiric therapy central lines, VP , hemodialysis , grafts , prosthetic valves §Prophylaxis](https://reader030.fdocuments.us/reader030/viewer/2022041015/5ec74947a6d01a5efb4915e7/html5/thumbnails/1.jpg)
Turki AlhaloolMD ,PEC /HMC
Third QPEM Conference January 11-13, 2019
Vancomycin or Clindamycin?
![Page 2: Vancomycin or Clindamycin?q-pem.com/wp-content/uploads/2019/04/2019-QPEM-PPT... · 2019-04-03 · §Empiric therapy central lines, VP , hemodialysis , grafts , prosthetic valves §Prophylaxis](https://reader030.fdocuments.us/reader030/viewer/2022041015/5ec74947a6d01a5efb4915e7/html5/thumbnails/2.jpg)
I do not have any relevant financial relationship with commercial interest to disclose.
DISCLOSURE
![Page 3: Vancomycin or Clindamycin?q-pem.com/wp-content/uploads/2019/04/2019-QPEM-PPT... · 2019-04-03 · §Empiric therapy central lines, VP , hemodialysis , grafts , prosthetic valves §Prophylaxis](https://reader030.fdocuments.us/reader030/viewer/2022041015/5ec74947a6d01a5efb4915e7/html5/thumbnails/3.jpg)
1
2
At the end of the presentation, the attendee will be able to:
Learning Objectives
Discuss the antimicrobial resistance to Vancomycin & Clinda.
Rational the use of Vancomycin and Clindamycin
Learning Objectives
![Page 4: Vancomycin or Clindamycin?q-pem.com/wp-content/uploads/2019/04/2019-QPEM-PPT... · 2019-04-03 · §Empiric therapy central lines, VP , hemodialysis , grafts , prosthetic valves §Prophylaxis](https://reader030.fdocuments.us/reader030/viewer/2022041015/5ec74947a6d01a5efb4915e7/html5/thumbnails/4.jpg)
Antimicrobial Resistance
![Page 5: Vancomycin or Clindamycin?q-pem.com/wp-content/uploads/2019/04/2019-QPEM-PPT... · 2019-04-03 · §Empiric therapy central lines, VP , hemodialysis , grafts , prosthetic valves §Prophylaxis](https://reader030.fdocuments.us/reader030/viewer/2022041015/5ec74947a6d01a5efb4915e7/html5/thumbnails/5.jpg)
Antimicrobial Resistance continue..
![Page 6: Vancomycin or Clindamycin?q-pem.com/wp-content/uploads/2019/04/2019-QPEM-PPT... · 2019-04-03 · §Empiric therapy central lines, VP , hemodialysis , grafts , prosthetic valves §Prophylaxis](https://reader030.fdocuments.us/reader030/viewer/2022041015/5ec74947a6d01a5efb4915e7/html5/thumbnails/6.jpg)
Vancomycin
§Bactericidal glycopeptide antibiotic
§First used clinically in 1958
§Treat infections caused by Gram –Positive organisms like MRSA and amoxicillin resistant Enterococcus species
§ Inhibits bacterial cell wall synthesis
![Page 7: Vancomycin or Clindamycin?q-pem.com/wp-content/uploads/2019/04/2019-QPEM-PPT... · 2019-04-03 · §Empiric therapy central lines, VP , hemodialysis , grafts , prosthetic valves §Prophylaxis](https://reader030.fdocuments.us/reader030/viewer/2022041015/5ec74947a6d01a5efb4915e7/html5/thumbnails/7.jpg)
Parenteral§MRSA or beta- lactam resistant CA -ve Staph§Serious/ life-threatening allergic to penicillin/ cephalosporin§Empiric therapy central lines, VP , hemodialysis , grafts , prosthetic valves § Prophylaxis for PD catheters :
-invasive GIT procedure-touch contamination
§Treatment of peritonitis in patients with PD cath
Oral
§Clostridioides difficileinfection
§Enterocolitis caused by Staph A
Vancomycin Use
![Page 8: Vancomycin or Clindamycin?q-pem.com/wp-content/uploads/2019/04/2019-QPEM-PPT... · 2019-04-03 · §Empiric therapy central lines, VP , hemodialysis , grafts , prosthetic valves §Prophylaxis](https://reader030.fdocuments.us/reader030/viewer/2022041015/5ec74947a6d01a5efb4915e7/html5/thumbnails/8.jpg)
Dosing: < 60 mg/kg/dayis not enough
Vancomycin continue..
![Page 9: Vancomycin or Clindamycin?q-pem.com/wp-content/uploads/2019/04/2019-QPEM-PPT... · 2019-04-03 · §Empiric therapy central lines, VP , hemodialysis , grafts , prosthetic valves §Prophylaxis](https://reader030.fdocuments.us/reader030/viewer/2022041015/5ec74947a6d01a5efb4915e7/html5/thumbnails/9.jpg)
Vancomycin continue..
e
§Adverse ReactionsØ hypotension, neutropenia, flushing (red man syndrome),
DRESS syndrome, ototoxicity, renal failure
§PrecautionsØExtravasation & phlebitisØDisease related concernØAppropriate use
![Page 10: Vancomycin or Clindamycin?q-pem.com/wp-content/uploads/2019/04/2019-QPEM-PPT... · 2019-04-03 · §Empiric therapy central lines, VP , hemodialysis , grafts , prosthetic valves §Prophylaxis](https://reader030.fdocuments.us/reader030/viewer/2022041015/5ec74947a6d01a5efb4915e7/html5/thumbnails/10.jpg)
Clindamycin
§ Advantages :Ø Achieves high intracellular levels in phagocytic
cellsØ High levels in boneØ Reduce toxin production
§Lincosamide FDA approved for the treatment of anaerobes, strept and staph infections
![Page 11: Vancomycin or Clindamycin?q-pem.com/wp-content/uploads/2019/04/2019-QPEM-PPT... · 2019-04-03 · §Empiric therapy central lines, VP , hemodialysis , grafts , prosthetic valves §Prophylaxis](https://reader030.fdocuments.us/reader030/viewer/2022041015/5ec74947a6d01a5efb4915e7/html5/thumbnails/11.jpg)
Clindamycin continue..
Mechanism of action
§ Bacteriostatic and bactericidal against some strains of staph, strept and anaerobes (Bacteroides fragilis)
§ Killing activity :concentration, bacterial species & inoculum
§ Inhibits production of staph toxin associated with TSS
§ Inhibits alpha toxin expression in S. aureus
![Page 12: Vancomycin or Clindamycin?q-pem.com/wp-content/uploads/2019/04/2019-QPEM-PPT... · 2019-04-03 · §Empiric therapy central lines, VP , hemodialysis , grafts , prosthetic valves §Prophylaxis](https://reader030.fdocuments.us/reader030/viewer/2022041015/5ec74947a6d01a5efb4915e7/html5/thumbnails/12.jpg)
§RTI, skin & soft tissue and female pelvis &genital
§Sepsis and intra-abdominal infections
§Treatment of peritonitis for patients with PD catheters
§Treatment of babesiosis and malaria
§Prophylaxis : endocarditis, preoperative, and peritonitis in patients with PD catheters
Clindamycin Use
![Page 13: Vancomycin or Clindamycin?q-pem.com/wp-content/uploads/2019/04/2019-QPEM-PPT... · 2019-04-03 · §Empiric therapy central lines, VP , hemodialysis , grafts , prosthetic valves §Prophylaxis](https://reader030.fdocuments.us/reader030/viewer/2022041015/5ec74947a6d01a5efb4915e7/html5/thumbnails/13.jpg)
Clindamycin continue..
§The commonest adverse effects are diarrhea and allergic reactions.
§There is increasing resistance through modification of the target, inactivation of the drug or efflux of the drug
§Use with caution in patient receiving neuromuscular blocking drugs
§ Do not use in combination with macrolids and chloramphenicol
![Page 14: Vancomycin or Clindamycin?q-pem.com/wp-content/uploads/2019/04/2019-QPEM-PPT... · 2019-04-03 · §Empiric therapy central lines, VP , hemodialysis , grafts , prosthetic valves §Prophylaxis](https://reader030.fdocuments.us/reader030/viewer/2022041015/5ec74947a6d01a5efb4915e7/html5/thumbnails/14.jpg)
Vancomycin vs Clindamycin Character Vancomycin Clindamycin
Category Glycopeptide Lincosamide
Mechanism of action Bactericidal, inhibit cell wall synthesis
Bacterioststic, inhibit toxin production
Uses MRSA severe infectionsClostridioides difficile
Bone ,skin and soft tissue infections
Advantages No or low resistance High levels in the boneReduce toxin production
Adverse reactions Red man syndrome Antibiotic associated diarrhea
![Page 15: Vancomycin or Clindamycin?q-pem.com/wp-content/uploads/2019/04/2019-QPEM-PPT... · 2019-04-03 · §Empiric therapy central lines, VP , hemodialysis , grafts , prosthetic valves §Prophylaxis](https://reader030.fdocuments.us/reader030/viewer/2022041015/5ec74947a6d01a5efb4915e7/html5/thumbnails/15.jpg)
Take home messages
Increasing antibiotic resistance warranting proper selection to ensure adequacy of treatment
Vancomycin still the drug of choice for severe infections of MRSA and MSSA
Clindamycin has adventages of good penetration for local infections and toxin production inhibition
![Page 16: Vancomycin or Clindamycin?q-pem.com/wp-content/uploads/2019/04/2019-QPEM-PPT... · 2019-04-03 · §Empiric therapy central lines, VP , hemodialysis , grafts , prosthetic valves §Prophylaxis](https://reader030.fdocuments.us/reader030/viewer/2022041015/5ec74947a6d01a5efb4915e7/html5/thumbnails/16.jpg)
![Page 17: Vancomycin or Clindamycin?q-pem.com/wp-content/uploads/2019/04/2019-QPEM-PPT... · 2019-04-03 · §Empiric therapy central lines, VP , hemodialysis , grafts , prosthetic valves §Prophylaxis](https://reader030.fdocuments.us/reader030/viewer/2022041015/5ec74947a6d01a5efb4915e7/html5/thumbnails/17.jpg)
References
• Up to date• PubMed• Annual Antibiogram Report 2017, Microbiology Division/ HMC• O Neill J. December 2014• American society for Microbiology, December 2015