Practical information on using glycopeptides

The glycopeptides teicoplanin and vancomycin are active against a wide range of gram-positive bacteria; gram-negative bacteria are not susceptible.

The primary indication for parenteral glycopeptides is treatment of infection with methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant coagulase-negative staphylococci (eg Staphylococcus epidermidis) and Enterococcus faecium. Glycopeptides are sometimes used for prophylaxis of these infections.

Teicoplanin and vancomycin may be associated with selection of glycopeptide-resistant bacteria (eg vancomycin-resistant enterococci [VRE])Harbarth, 2002Remschmidt, 2017. If a glycopeptide is indicated, vancomycin is preferred to teicoplanin because of greater clinical experience with its use and lower likelihood of resistance developing. In some centres, teicoplanin is used as an alternative to vancomycin because, unlike vancomycin, it does not require a long infusion.

Oral vancomycin is used to treat Clostridioides difficile (formerly known as Clostridium difficile) infection. In patients with severe disease, particularly in the presence of ileus, vancomycin can be given as a retention enema in addition to oral therapy. Intravenous vancomycin is not effective against C. difficile infection because of inadequate penetration of the drug into the lumen of the colon.

For information on vancomycin dosing and monitoring, see Principles of vancomycin use in adults and Principles of vancomycin use in young infants and children.

For information on monitoring teicoplanin plasma concentration, see Monitoring teicoplanin blood concentrations.