Lipoglycopeptide antibiotics: Reliable fighters against gram-positive pathogens

Abstract

Multi-drug resistant (MDR) strains of staphylococci are usually difficult to treat. Vancomycin has had a time-honored niche in treating MDR Staphylococcus strains; however, during recent years, many clinical failures have been reported worldwide. Since 2014, new semisynthetic lipoglycopeptides antibiotics have been introduced to combat methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-intermediate Staphylococcus aureus (VISA), vancomycin-resistant Staphylococcus aureus (VRSA), and vancomycin-resistant enterococci (VRE). They include dalbavancin, oritavancin, and telavancin. These semisynthetic lipoglycopeptides have a considerable efficacy against MDR Staphylococcus strains. Due to the presence of a lipid side chain, the half-life is prolonged and enables them to anchor the cell membrane of a pathogen. Lipoglycopeptides display a greater potency and more consistent activity against all species of staphylococci than vancomycin. Among them, oritavancin is active against MRSA, VISA, and VRSA. However, dalbavancin and telavancin have activities against MRSA and VISA. Dalbavancin is used once weekly, telavancin is used daily, and oritavancin is usually administered one dose per treatment. Compared to vancomycin, these semisynthetic lipoglycopeptides have longer half-lives with a lower minimum inhibitory concentration (MIC) and fast bactericidal activities. In addition, lipoglycopeptides have concentration-dependent effects in vivo and in vitro. In the present paper, we review the structure, mechanism of action, microbiology, indications, safety, and important interactions of dalbavancin, oritavancin, and telavancin.