Vancomycin lung penetration
Supplemental Digital Content is available for this article. Submitted for publication January 14, Accepted for publication January 6, Published online first on February 10, Intravenous vancomycin is used to treat ventilator-associated pneumonia caused by methicillin-resistant Staphylococcus aureus , but achieves high rates of failure. Vancomycin nebulization may be efficient to provide high vancomycin lung tissue concentrations.
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Although antibiotics whose epithelial lining fluid ELF concentrations are reported high tend to be preferred in treatment of pneumonia, measurement of ELF concentrations of antibiotics could be misled by contamination from lysis of ELF cells and technical errors of bronchoalveolar lavage BAL. In this review, ELF concentrations of anti-methicillin resistant Staphylococcus aureus MRSA antibiotics were interpreted considering above confounding factors. ELF concentrations of oritavancin, telavancin, tigecycline, and vancomycin were well described by the diffusion equation, with or without additional impact from cell lysis. Keywords: Epithelial lining fluid ; Methicillin-resistant Staphylococcus aureus ; Bronchoalveolar lavage ; Protein binding. With an equation reflecting protein binding and penetration capacity through cellular barrier, low ELF concentrations of beta-lactams could be explained with poor penetration of their free fraction through the tightly linked alveolar epithelium.
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The rapid antibiotic resistance development has created a major demand for new antimicrobial agents that can combat resistant strains such as methicillin-resistant S. Until a short time ago, the glycopeptide vancomycin was the only therapeutic choice in this situation. However, in recent years some newer agents with different mechanisms of actions have been added to the arsenal, and more are on the horizon. For a successful therapy it is of vital importance that these compounds are used judiciously and dosed appropriately.
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