Side by side

1. 1.Binds D-Ala-D-Ala cell-wall precursors, blocking peptidoglycan cross-linking.
2. 2.Its lipophilic side chain anchors it in the membrane and drives the very long half-life.
3. 3.Bactericidal against staphylococci and streptococci, including MRSA.
4. 4.Remains above the MIC for days after a single dose.
5. 5.Not active against Gram-negative bacteria or enterococci to a useful degree.

• Acute bacterial skin and skin structure infection (DISCOVER 1 and 2)
• Outpatient parenteral therapy for Gram-positive infection
• Bone and joint infection (increasingly used, off-label)
• Osteomyelitis and prosthetic joint infection in observational series

• Clinical cure rates non-inferior to vancomycin plus linezolid in the DISCOVER trials
• Therapeutic levels maintained for one to two weeks after dosing
• Fewer infusion days and earlier discharge in practice studies
• Infusion reactions and rash as the main tolerability issues

• Nausea and diarrhoea
• Rash and pruritus
• Infusion-related reactions
• Raised liver enzymes
• Headache
• Rare hypersensitivity including severe cutaneous reactions

Research context only - a hospital antibiotic. Licensed regimens are a single 1500 mg intravenous dose, or 1000 mg followed one week later by 500 mg; the DISCOVER trials compared this against vancomycin with optional linezolid switch, with cure assessed at 48 to 72 hours and again at test-of-cure around day 14.

Research context only