This glycopeptide antibiotic, like vancomycin, has bactericidal activity against both aerobic and anaerobic Gram-positive bacteria: Staphylococcus aureus, including MRSA, Streptococcus spp., Listeria spp. and Clostridium spp. It is only bacteriostatic for most Enterococcus spp. It does not cause ‘red man’ syndrome through histamine release and is less nephrotoxic than vancomycin. However, due to the variation between patients, effective therapeutic levels for severe infections may not be reached for a number of days using the most commonly recommended dosage schedules. Serum monitoring of pre-dose levels can be undertaken, particularly for severe infections.
In the UK resistance is well recognized in enterococci and coagulase-negative staphylococci and, more worryingly, is now emerging in S. aureus.