Vancomycin Hydrochloride Narrow-spectrum Glycopeptide Antimicrobials

English name：Vancomycin hydrochloride

CAS number：1404-93-9

Molecular formula: C66H76Cl3N9O24

Molecular weight: 1485.72

EINECS number: 604-193-8

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Mol file：1404-93-9.mol

Structural formula:

Properties of vancomycin hydrochloride

Melting point :>190°C(dec.)

Specific rotation :[α]D20-30 ~ -40゜(c=1,H2O)

Flash point :87℃

Storage conditions :2-8°C

Solubility :H2O: 50mg/mL, clear, yellow

Form: Powder

Color: Colorless to light yellow or brown

PH value :pH(50g/l,25℃):2.5 ~ 4.Chemicalbook5

Biological origin : Streptomyces orientalis

Water solubility: Soluble in water. Slightly soluble in methanol, ethanol and dimethylsulfoxide.

Sensitivity : Hygroscopic

Merck：13,9995

BRN：3704657

Stability：hygroscopicity

Glycopeptide antibiotics

Vancomycin hydrochloride is a glycopeptide antibiotic, which is the hydrochloride of vancomycin and white or white crystalline powder at room temperature. Its mechanism of action is to bind alanyl alanine to the polyterminal of the precursor peptide of sensitive bacterial cell wall with high affinity, block the synthesis of polymeric peptidoglycan constituting bacterial cell wall, cause cell wall defects and kill bacteria. In addition, it may also alter bacterial cell membrane permeability and selectively inhibit RNA synthesis. Vancomycin hydrochloride has strong bactericidal action against gram-positive bacteria, Staphylococcus aureus, Staphylococcus epidermidis, streptococcus pyogenes, streptococcus pneumoniae and so on. It also has certain antibacterial effect on anaerobic streptococcus, Clostridium difficile, Bacillus anthracis, actinomyces, Bacillus diphtheriae, gonococcus, Streptococcus viridiae, Streptococcus bovis, Streptococcus faecalis, etc. It is not effective against most Gram-negative bacteria, Mycobacterium, Rickettsiella, Chlamydia or fungi. It is clinically suitable for the treatment of infections caused by methicillin-resistant Staphylococcus aureus and other bacteria: sepsis, infective endocarditis, osteomyelitis, arthritis, burn, surgical trauma and other superficial secondary infections, pneumonia, lung abscess, empyema, peritonitis, meningitis, pseudomembranous enteritis, skin and soft tissue infections. Enterococcal endocarditis and corynebacterium (diphtheriform) are the first choice for the treatment of endocarditis in patients with penicillin allergy.

Vancomycin

Vancomycin belongs to a class of polypeptide antibiotics. Glycopeptide antibiotics from StreptomycesOrientalis or AmycolatopsisOrientalis. In the late 1950s, the drug was developed for its good effect on penicillin-resistant Staphylococcus and became a powerful "trump card" antibiotic for G+ resistant bacteria such as Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae and so on. Later, due to the discovery of its greater toxicity, coupled with the less toxic anti-staphylococcal semi-synthetic penicillium Chemicalbook and cephalosporin have been listed in the 1960s, and the drug resistance problem at that time is not very acute, so that its application is limited. In recent years, due to the increase of methicillin-resistant staphylococcus aureus (MRSA), methicillin-resistant Staphylococcus epidermis (MRSE) infection, and the discovery that Clostridium difficile (CD) is the main cause of antibiotic-associated pseudomembranous enteritis, the application of vancomycin is increasing. It has re-established the special status of vancomycin in clinical practice, and has been praised by international antibiotic experts as "the last line of defense for human beings to deal with refractory drug-resistant strains" since the 1990s.

According to the results of some literatures and the distribution of current clinical drug-resistant strains, vancomycin is the preferred drug for diseases caused by MRSA and MRSE infection. Vancomycin is also quite positive for the treatment of CD-associated diarrhea or pseudomembranous enteritis, especially in critically ill patients. In addition, the rare penicillin G resistant pneumococcal infection and severe infection caused by penicillin resistant corynebacterium JK strain, vancomycin is also the top product.

Since vancomycin has a good effect on diseases caused by a variety of drug-resistant bacteria, its market sales have increased year by year in the past 10 years. The annual growth rate of vancomycin international market has been maintained at 3-4Chemicalbook% in the past few years, and has risen to 5-6% in the past two years. According to antibiotic experts, the global total production of vancomycin has averaged 20-25 tons per year in the 1990s, and has risen to 30 tons in 1999.

Pharmacokinetics

Oral malabsorption, intravenous administration can be widely distributed in most tissues and fluids throughout the body. The peak blood concentrations of 500mg /L and 1g /L were 10-30mg/L and 25-50mg/L, respectively.

The volume of distribution of this drug was 0.43-1.25L/kg. The effective antibacterial concentration can be achieved in serum, pericardium, pleura, peritoneum, ascites and synovial fluid, but not in bile Chemicalbook. Vancomycin hydrochloride transits the placenta but does not rapidly cross the normal blood-cerebrospinal fluid barrier, and can penetrate the cerebrospinal fluid and reach effective antibacterial concentrations when the meninges are inflamed.

The protein binding rate of this drug was about 55%. The elimination half-life in adults averages 6 hours (4-11 hours) and can be extended to 7.5 days in severe renal insufficiency. Children about 2-3 hours. The drug is metabolized by the liver, about 80%-90% of the chemical is excreted in its original form through the kidney within 24 hours, and a small amount is excreted with bile and milk. Hemodialysis or peritoneal dialysis can not effectively clear the drug; However, it has been reported that blood perfusion or blood filtration can improve clearance.

Administration instructions

1. This drug has a strong irritation to the tissue and is not suitable for intramuscular or intravenous injection; The leakage of the liquid should be avoided as much as possible during intravenous infusion.
2. In order to reduce the incidence of adverse reactions (such as "red neck syndrome" and thrombophlebitis), the rate of intravenous infusion should not be too fast, and the time of each infusion should be at least 1 hour.
3. When treating staphylococcal endocarditis, the course of treatment should not be less than 28 days.
4. Vancomycin hydrochloride is contraindicated with chloramphenicol, heparin, aminophylline, sodium bicarbonate, steroid, methicillin, heavy metal-containing drugs, alkaline solution, etc.
5. Management of overdose: Excessive use of vancomycin hydrochloride can cause oliguria and kidney failure. Management includes: (1) symptomatic and supportive treatment. (2) Routine hemodialysis and peritoneal dialysis are ineffective in removing drugs; However, hemoperfusion or hemofiltration can increase drug clearance.
6. Solution preparation: (1) Preparation of oral liquid: Each bottle containing 500mg of vancomycin is diluted with distilled water to make a 500mg/6ml solution for oral consumption. The oral liquid can be stored for 14 days in a refrigerator at 4℃. (2) Preparation of intravenous infusion solution: ① For intermittent infusion, the solution is prepared with 500mg of medicine and 10ml of water, and then added to 5% glucose injection or 0.9% sodium chloride into the Chemicalbook infusion, so that it is diluted to less than 5mg/ml, and then the infusion is performed. At least 60 minutes for a 500mg dose or 100 minutes for a 1000mg dose. For patients who need to limit the amount of fluid, the maximum concentration can be 10mg/ml. ② For continuous intravenous infusion, the dose of 1 to 2g should be added to the sufficient amount of 5% glucose injection or 0.9% sodium chloride injection.
7. Maintenance in patients with renal dysfunction is calculated as follows: maintenance dose (md/d)=150+(15 x patient creatinine clearance ml/min).
8. The peak concentration should not exceed 25 ~ 40μg/ml and the trough concentration should not exceed 5 ~ 10μg/ml. Higher than 60μg/ml is the toxic range. If the blood concentration cannot be monitored, adjust the dose according to creatinine clearance.

Adverse reaction

Clinically, the main adverse reactions of vancomycin hydrochloride are as follows:

Ototoxicity: can appear tinnitus or ear fullness, hearing loss or loss, auditory nerve damage. It is especially easy to occur when used in large doses, for a long time, in the elderly or in patients with renal insufficiency.

Nephrotoxicity: mainly damage the renal tubules. Proteinuria and tubularia may occur in the early stage, followed by hematuria and oliguria. Severe cases can lead to kidney failure. It is especially easy to occur in large doses (blood concentration of more than 60 to 100mg/L), for a long time, the elderly or people with renal insufficiency.

Allergy: "red neck syndrome" may occur in a small number of patients with rapid, high dose intravenous administration. Present with chills or fever, fainting, itching, nausea, vomiting, tachycardia, rash, or facial flushing; Redness or tingling in the neck, upper body, back, and arms (due to histamine release), occasionally with hypotension and shock-like symptoms. The incidence was higher than that of norvancomycin and teicoplanin.

Local reaction: Severe pain at the injection site may occur during intramuscular or intravenous administration, which may lead to thrombophlebitis in severe cases.

Gastrointestinal tract: Oral administration may have nausea, vomiting, and bad breath.

Use

Narrow antibacterial spectrum, mainly effective against Gram-positive bacteria

It is a narrow spectrum antibiotic, which is only effective against gram-positive bacteria, such as hemolytic streptococcus, pneumococcus, gonococcus and enterococcus, etc., and sensitive to drug-resistant Staphylococcus aureus. Its mechanism of action is to inhibit the synthesis of the bacterial cell wall, which mainly binds to the bacterial cell wall, and makes certain amino acids unable to enter the glycopeptides of the cell wall.

Safety information

Dangerous Goods Mark :Xi

Danger category code :43-42

Safety Instructions :36/37-24/25-22-36

WGK Germany：2

F：8-10-21

Customs Code :29419090

Toxicity：LD50 in mice (mg/kg): 489 i.v.; 1734 i.p.; 5000 s.c.; 5000 orally (Anderson)

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