Other inhibitors of cell wall

:

1- Vancomycin: 

 - It is a glycopeptide

 - Is active only against gram positive bacteria.

 - It is poorly absorbed from the GIT and given orally only in treatment of antibiotic associated enterococci caused by clostridium difficile.

Parenteral dose is given by infusion

90% of the drug is excreted by glomerular filtration

Indications:

-         Infection caused by Methicillin resistant staphylococcus (MRSA)

-         Enterococcal endocarditis in patient with serious penicillin allergy.

Dose is 1 gm IV 12 hourly

Oral Vancomycin is 250 mg 6 hourly

Adverse reactions:

·        Irritation at the site of injection

·        Chills and fever.

·        Ototoxicity and nephrotoxicity (Rare)

·        Red man syndrome due to release of histamine.

2- Bacitracin:

Is acyclic peptide mixture.

Active against gram positive microorganisms.

Markedly nephrotoxic.  

Limited to topical use only.