Vancomycin and Teicoplanin

Mechanism of Action and Range

  • All glycopeptides act on the bacterial cell wall (bacteriocidal)
    • Inhibits cell wall peptidoglycan synthesis by forming complexes with D-alanine residues on peptidoglycan precursors
  • Because they are unable to penetrate the outer liposaccharide layer of gram-negative organisms, their use is restricted to gram-positive organisms
    • Useful against gram-positive cocci which are resistant to penicillins
    • However, their use should be restricted as more strains are becoming resistant


  • Both require IV/IM administration except in C diff infection where vancomycin can be given orally
  • Little distribution to the CSF
  • ~55% bound to plasma proteins
  • Eliminated mainly by kidneys (>80%), the majority within 24 hours
    • Note, however, that glycopeptides generally take a while to work (>24 hours), therefore multiple doses must be given.
    • Due to risk of nephrotoxicity, patients must have vancomycin levels and U&Es/eGFR monitored regularly (trough concentrations.  Note that the loading dose is also based on patient weight (see prescribing below)
      • Aim for levels >10mg/l
  • Synergistic effect with aminoglycosides


For NHS Tayside Vancomycin prescribing protocol, see Vancomycin Protocol June 11

NB There are also teicoplanin dosing protocols (see formulary)

Typically used for serious infections e.g. endocarditis.

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