[Vancomycin, what else?]. / Faut-il abandonner la vancomycine?

ABSTRACT

Vancomycin and teicoplanin are glycopeptidic antibiotics that are used for many years in infections due to methicillin-resistant Staphylococcus aureus (MRSA). Nephrotoxicity of vancomycin and a slow clinical efficacy lead to discuss alternatives. Glycopeptides are less active than oxacillin against staphylococci susceptible to methicillin and should be reserved for infections due to MRSA. MRSA prevalence has decreased for several years in pediatrics but may remain frequent in neonatal intensive care units. Coagulase-negative staphylococci are a major cause of infections in neonates and are often resistant to methicillin. Community-acquired MRSA that produce Panton-Valentine leucocidin and are responsible for severe cutaneous infections and for rare severe necrotizing pneumonia in children spread over several years but their frequency remains low in France (2-4 % of MRSA). A new community-acquired MRSA clone, producer of toxic shock staphylococcal toxin is increasingly isolated. Efficacy of vancomycin against staphylococci is inversely correlated with MIC. MIC should be determined in severe infections and a seric concentration of vancomycin of 8 times the MIC should be reached as a target value. Glycopeptide resistance is rare in Staphylococcus aureus, but not that to teicoplanin in coagulase-negative staphylococci. MRSA remain currently susceptible to several antibiotics in addition to glycopeptides. Linezolid and daptomycin, recently introduced in therapy, have no indication in children but may have an interest.