Side by side

1. 1.Binds D-Ala-D-Ala precursors and blocks peptidoglycan cross-linking, like vancomycin.
2. 2.Bactericidal against dividing Gram-positive bacteria.
3. 3.Its long fatty acid chain anchors it in the bacterial membrane, which slows clearance and lengthens its half-life.
4. 4.Not absorbed orally, so the oral form is used only for gut infections.
5. 5.Ineffective against Gram-negative organisms.

• Complicated skin and soft tissue infection
• Bone and joint infection, including outpatient therapy
• Endocarditis caused by Gram-positive organisms
• Clostridioides difficile infection (oral)
• Surgical prophylaxis in some European centres

• Clinical cure rates broadly comparable to vancomycin in comparative trials
• Once-daily maintenance dosing after loading
• Less infusion-related flushing than vancomycin
• Nephrotoxicity reported, though possibly less than with vancomycin

• Rash, including rare severe cutaneous reactions
• Thrombocytopenia
• Raised liver enzymes
• Nephrotoxicity
• Injection-site pain
• Infusion-related reactions

Research context only - a hospital antibiotic. Loading is typically 6 mg per kilogram (up to 12 mg per kilogram for serious infection) every 12 hours for three to five doses, then once daily with dose adjustment for kidney function; trough levels are monitored in serious infection. Comparative trials assess clinical and microbiological cure at end of treatment.

Research context only