vancomycin
Sources réglementaires consultées
Indications approuvées
- Infections systémiques graves dues à des germes à Gram positif sensibles, notamment bactériémie, endocardite, infections ostéoarticulaires, pneumonie nosocomiale et méningite, lorsque la vancomycine IV est indiquée.
Contre-indications
Absolues
- Hypersensibilité à la vancomycine.
- Administration intramusculaire : interdite en raison du risque de nécrose tissulaire.
Mises en garde cliniques
- Il peut provoquer une atteinte rénale aiguë ; le risque augmente avec une exposition élevée, un traitement prolongé, une maladie critique et d’autres néphrotoxiques. Surveiller la fonction rénale et l’exposition. — CIMA/AEMPS, ficha técnica 85651
- Mise en garde majeure · Une perfusion rapide peut provoquer une réaction liée à la perfusion avec rougeur, prurit, hypotension et douleur thoracique ou musculaire ; arrêter ou ralentir la perfusion et traiter les symptômes. — CIMA/AEMPS, ficha técnica 85651
- Mise en garde majeure · Il peut provoquer une ototoxicité et une neutropénie ; surveiller l’audition en cas de risque et la numération lors des traitements prolongés. — CIMA/AEMPS, ficha técnica 85651
Interactions médicamenteuses
- SévèreAutres médicaments néphrotoxiques, dont les aminosides
Mécanisme: La néphrotoxicité peut être additive.
Recommandation: Éviter l’association si possible ; si elle est indispensable, intensifier la surveillance de la créatinine et le suivi pharmacologique.
CIMA/AEMPS, ficha técnica 85651
- SévèreAnesthésiques et bloquants neuromusculaires
Mécanisme: Ils peuvent augmenter l’hypotension, la réaction de perfusion ou le bloc neuromusculaire.
Recommandation: Administrer sous surveillance hémodynamique et respiratoire étroite.
CIMA/AEMPS, ficha técnica 85651
Effets indésirables
Communs (≥1%)
Phlébite, réaction liée à la perfusion et nausées
Rares mais graves
Anaphylaxie, atteinte rénale aiguë, ototoxicité et neutropénie sévère
Grossesse et allaitement
Utiliser pendant la grossesse uniquement en cas d’indication claire. Il passe dans le lait ; évaluer le bénéfice et le risque et surveiller le nourrisson.
Bibliographie récente (PubMed)
The opportunistic pathogen Enterococcus faecium colonizes humans and a wide range of animals, endures numerous stresses, resists antibiotic treatment and stubbornly persists in clinical environments. The widespread application of antibiotics in hospitals and agriculture has contributed to the emergence of vancomycin-resistant E. faecium, which causes many hospital-acquired infections. In this Review, we explore recent discoveries about the evolutionary history, the environmental adaptation and the colonization and dissemination mechanisms of E. faecium and vancomycin-resistant E. faecium. These studies provide critical insights necessary for developing novel preventive and therapeutic approaches against vancomycin-resistant E. faecium and also reveal the intricate interrelationships between the environment, the microorganism and the host, providing knowledge that is broadly relevant to how antibiotic-resistant pathogens emerge and endure.
Vancomycin-resistant enterococci (VRE) are common causes of bloodstream infections (BSIs) with high morbidity and mortality rates. They are pathogens of global concern with a limited treatment pipeline. Significant challenges exist in the management of VRE BSI, including drug dosing, the emergence of resistance, and the optimal treatment for persistent bacteremia and infective endocarditis. Therapeutic drug monitoring (TDM) for antimicrobial therapy is evolving for VRE-active agents; however, there are significant gaps in the literature for predicting antimicrobial efficacy for VRE BSIs. To date, TDM has the greatest evidence for predicting drug toxicity for the three main VRE-active antimicrobial agents daptomycin, linezolid, and teicoplanin. This article presents an overview of the treatment options for VRE BSIs, the role of antimicrobial dose optimization through TDM in supporting clinical infection management, and challenges and perspectives for the future.
To review recently published evidence relevant to Staphylococcus aureus bacteremia (SAB). Staphylococcus aureus is the most common pathogen causing co-infections and superinfections in patients with COVID-19. Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia ratios have sharply risen during the pandemic. SAB mortality is 18% at 1 month and 27% at 3 months but has gradually decreased over the last 30 years. Recurrences and reinfections are common (9%). Standardised items to define complicated SAB, and a new cut-off defining persisting bacteremia after 2 days with positive blood cultures have been proposed. Multiple antibiotic combinations have been trialled including vancomycin or daptomycin with β-lactams, fosfomycin, or clindamycin, without significant results. In the recently published guidelines, vancomycin remains the first line of treatment for MRSA bacteremia. For the management of methicillin-susceptible Staphylococcus aureus , cefazolin less frequently causes acute kidney injury than flucloxacillin, and when susceptibility is demonstrated, de-escalation to penicillin G is suggested. Our review confirms that Staphylococcus aureus represents a special aetiology among all causes of bloodstream infections. Pending results of platform and larger trials, its distinct epidemiology and determinants mandate careful integration of clinical variables and best available evidence to optimize patient outcomes.
The aim of these guidelines is to provide recommendations for decolonization and perioperative antibiotic prophylaxis (PAP) in multidrug-resistant Gram-positive bacteria (MDR-GPB) adult carriers before inpatient surgery. These European Society of Clinical Microbiology and Infectious Diseases/European Committee on Infection Control guidelines were developed following a systematic review of published studies targeting methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, methicillin-resistant coagulase-negative Staphylococci, and pan-drug-resistant-GPB. Critical outcomes were the occurrence of surgical site infections (SSIs) caused by the colonizing MDR-GPB and SSIs-attributable mortality. Important outcomes included the occurrence of SSIs caused by any pathogen, hospital-acquired infections, all-cause mortality, and adverse events associated with the interventions, including resistance development to the agents used and the incidence of Clostridioides difficile infections. The last search of all databases was performed on 1 November 2023. The level of evidence and the strength of each recommendation were defined according to the Grading of Recommendations Assessment, Development, and Evaluation approach. Consensus of a multidisciplinary expert panel was reached for the final list of recommendations. Antimicrobial stewardship considerations were included. The guideline panel reviewed the impact of decolonization, targeted PAP, and combined interventions (e.g. decolonization and targeted PAP) on the risk of SSIs and other outcomes in MDR-GPB carriers, according to the type of bacteria and type of surgery. We recommend screening for S. aureus before high-risk operations, such as cardiothoracic and orthopaedic surgery. Decolonization with intranasal mupirocin with or without a chlorhexidine bath is recommended in patients colonized with S. aureus before cardiothoracic and orthopaedic surgery and suggested in other surgeries. The addition o
Mastocytosis is a rare neoplastic disorder of the mast cell lineage resulting in unregulated proliferation and activation of mast cells. Symptoms worsen in about one-third of pregnant patients. Treatment focuses on management of symptoms with antimediator therapy (H1 & H2 antihistamines, glucocorticoids, and epinephrine, if required). Medication selection requires care during labor and delivery. Although it is generally considered safe to use a medication patient tolerated before, some common medications may need to be avoided or used with caution (eg, codeine, morphine, nonsteroidal antiinflammatory drugs, vancomycin) if the patient does not have any history of exposure to them.