Oxazolidinonas y glucopéptidos

Pigrau, Carlos

doi:10.1016/S0213-005X(03)72907-3

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Se revisan la estructura química, la farmacocinética, el espectro de actividad, los mecanismos de acción, las resistencias, las indicaciones y los efectos adversos de dos grupos de antibióticos: oxazolidinonas (linezolid) y glucopéptidos. Las oxazolidinonas inhiben la síntesis proteica y los glucopéptidos la síntesis de la pared bacteriana. Su espectro de actividad va dirigido fundamentalmente contra microorganismos grampositivos, incluidos los multirresistentes. Linezolid se absorbe el 100% y puede administrarse por vía oral o vía intravenosa; tiene un metabolismo mixto, por lo cual no es necesario ajustar la dosis en la insuficiencia renal o hepática moderadas. Los glucopéptidos no se absorben por vía oral y se eliminan por vía renal (ajustar dosis en insuficiencia renal). Sus principales indicaciones son las infecciones por grampositivos multirresistentes, siendo linezolid, además, eficaz frente a enterococos resistentes a los glucopéptidos. Linezolid puede causar trombopenia si la duración del tratamiento es superior a 2 semanas. El principal efecto secundario de vancomicina es su nefrotoxicidad, y teicoplanina puede causar fiebre

Palabras clave:

Oxazolidinonas

Linezolid

Glucopéptidos

Vancomicina

Teicoplanina

We review the chemical structure, pharmacokinetics, antimicrobial spectrum, mechanisms of action and resistance, clinical use and adverse effects of oxazolidinones (linezolid) and glycopeptides. Oxazolidinones inhibit protein synthesis and glycopeptides cell wall synthesis. Antibacterial spectra cover grampositive pathogens, including multiresistant organisms. Linezolid has a 100% absorption and can be administered orally or intravenously; it is cleared by renal and hepatic routes, thus dose adjustments are not needed in moderate renal or hepatic failure. Oral absorption of glycopeptides is minimal. They are excreted by the kidneys (dose adjustments are needed in renal failure). The main clinical indications are the treatment of infections caused by grampositive pathogens; linezolid is also useful for infections caused by glycopeptide-resistant enterococcal infections. Linezolid can cause trombocytopenia when treatment lasted longer than two weeks. The main side effect of vancomycin is its nefrotoxicity and teicoplanin can cause fever

Key words:

Oxazolidinones

Linezolid

Glycopeptides

Vancomycin

Teicoplanin

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