Vancomycin and Preventing Infections Dissertation

Vancomycin and Preventing Infections - Dissertation Example Fig. 1: Tricyclic glycopeptide structure of vancomycin (Ouelette & Joyce, 2010, p. 207) The three-dimensional structure of vancomycin forms a cleft that allows it to bind to late stage PG intermediates that have a D-alanyl-D-alanine terminus (Corey et al., 2012). Vancomycin is selectively toxic since the sequences L-aa-D-aa-D-aa of the peptide PG intermediates are only found in the cell walls of bacteria. Fig. 2: Figure showing the PG intermediates and vancomycin with its cleft where it binds to the D-Ala-D-Ala terminus (Corey et al., 2012, p. 138) Hydrogen bonding between the vancomycin glycopeptide molecule and the peptides of PG intermediates results in the formation of stable complexes (Reynolds, 1989). This in turn leads to the inhibition of transglycosylation and transpeptidation reactions by two important enzymes as they fail to bind to the terminus due to steric hindrance. Because of this, the elongation of the glycan chain is inhibited. The mechanism of action of vancomycin thus involves the binding of a â€Å"bulky inhibitor† (vancomycin) to the substrate (D-alanyl-D-alanine terminus) outside the cell membrane because of which the active site of two bacterial enzymes (transglycosylase and transpeptidase) cannot align and bind to the substrate. This unique mechanism of action of vancomycin renders drug resistance by most bacteria difficult, unlike most other antibiotics (Reynolds, 1989). Vancomycin Usage Vancomycin is used to treat severe infections such as pneumonia, endocarditis, abscesses, and empyema caused by MRSA, and also for the treatment of patients allergic to cephalosporins and penicillins (Ouelette &... Significant information exists for vancomycin use in the hospital setting, but not so much for outpatient and use in the community setting. Challenges to proper usage of vancomycin may be caused due to lack of patient education, minimal studies in relation to patient education and improper compliance with best practice guidelines. Healthcare workers can sometimes lack proper understanding on correct dosage for patients. After extensive literature review, it is clear that improper preventive application or incorrect utilization of vancomycin may lead to the increased incidence of vancomycin resistant bacteria. It is thus imperative for healthcare institutions, healthcare workers and patients to comply with best practices regarding treatment with vancomycin as it is one of the few remaining antibiotics that can be used for the treatment of infections with multiple drug resistant bacteria or in patients with allergies to other common antibacterial agents.