Anti-infective
Glycopeptide antibiotics
Vancomycin and teicoplanin — Powerful antibiotics for serious Gram-positive infections including MRSA — needing careful level monitoring.
Education and reference only. This is a plain-language class overview — it deliberately contains no doses. Always check the current Summary of Product Characteristics (SmPC), the BNF and your local formulary before prescribing or administering any medicine.
Quick answer
What is Glycopeptide antibiotics?
Glycopeptides are powerful antibiotics used for serious infections caused by Gram-positive bacteria, including MRSA, usually given by drip. Oral vancomycin has a separate use for a specific gut infection (C.
- How it works: They block the building of the bacterial cell wall — at a different step from penicillins — so the bacteria cannot maintain their structure and die.
- In practice: In practice glycopeptides (vancomycin and teicoplanin) are important antibiotics for serious infections caused by Gram-positive bacteria, including MRSA and other resistant organisms, and for people with serious penicillin allergy.
What it is
Glycopeptides are powerful antibiotics used for serious infections caused by Gram-positive bacteria, including MRSA, usually given by drip. Oral vancomycin has a separate use for a specific gut infection (C. difficile), where it works locally in the bowel.
How it works
They block the building of the bacterial cell wall — at a different step from penicillins — so the bacteria cannot maintain their structure and die. This makes them effective against resistant Gram-positive organisms, while their handling by the kidneys explains why blood levels and kidney function must be watched.
In practice
In practice glycopeptides (vancomycin and teicoplanin) are important antibiotics for serious infections caused by Gram-positive bacteria, including MRSA and other resistant organisms, and for people with serious penicillin allergy. They are given by drip (intravenously) for infections in the blood, bones, heart valves and deep tissues. A separate, distinct use is oral vancomycin for Clostridioides difficile gut infection — where, unusually, the point is that it is NOT absorbed and acts locally in the bowel (so oral vancomycin does not treat infections elsewhere). The dominant practical theme for the intravenous route is monitoring: blood levels are measured and the dose adjusted to stay in a target range, because too little fails to treat the infection and too much risks harming the kidneys and, less commonly, hearing — effects that are watched with kidney-function and level checks, especially alongside other kidney- or ear-toxic drugs such as aminoglycosides. Vancomycin given too quickly can cause a flushing reaction ("red man syndrome"), avoided by infusing slowly. They are renally cleared, so dosing is adjusted in kidney impairment, and treatment is often prolonged and specialist-guided.
Examples
Practical use
How to take it & use it well
- These are powerful antibiotics, such as vancomycin and teicoplanin, used against serious infections caused by certain Gram-positive bacteria, including MRSA.
- Given into a vein, they need blood tests to check the level of the drug, as too little fails to clear the infection while too much can harm the kidneys and hearing.
- Vancomycin into a vein is run in slowly, because giving it too fast can cause flushing and a red rash known as red man syndrome, which settles when the drip is slowed.
- Expect your kidney function to be monitored during treatment, as these antibiotics can affect the kidneys, especially alongside other medicines that do the same.
- Vancomycin taken by mouth is a special case used only to treat a gut infection called C. difficile, as it stays in the bowel and is not absorbed to treat infection elsewhere.
- Complete the full course as directed and tell the team about any hearing changes, ringing in the ears or reduced urine, so treatment can be adjusted promptly.
Common uses
- Serious Gram-positive infections including MRSA
- Infections in serious penicillin allergy
- Oral vancomycin for C. difficile gut infection (acts locally)
Monitoring
- Drug blood levels and kidney function
- Hearing and balance where relevant, and other nephro/ototoxic drugs
- Clinical response over what is often a prolonged course
Weighing it up
Advantages & disadvantages
Advantages
- They are effective against serious Gram-positive infections, including resistant bacteria like MRSA.
- They give a reliable option when penicillin-type antibiotics cannot be used or will not work.
- Blood-level monitoring allows the dose to be tailored to keep treatment both safe and effective.
- Vancomycin taken by mouth is a key treatment for serious C. difficile gut infection.
- They are well established, with long experience of their use in hospital for difficult infections.
Disadvantages
- Given into a vein they can harm the kidneys, so careful blood-level and kidney monitoring is needed.
- They can affect hearing, particularly at high levels or alongside other drugs that do the same.
- Vancomycin given too quickly can cause flushing and a red rash, so it must be infused slowly.
- They are hospital treatments needing a drip and regular blood tests, not simple tablets for home.
- Getting the dose right is a balance, as too little fails and too much causes harm.
Key safety principles
What to watch for
- Intravenous use needs blood-level monitoring and kidney checks — too little fails, too much risks the kidneys and (less often) hearing.
- Greater kidney/ear risk alongside other toxic drugs (e.g. aminoglycosides); dose reduced in kidney impairment.
- Infuse vancomycin slowly to avoid a flushing reaction; oral vancomycin treats only the gut (C. difficile), not infection elsewhere.
Key interactions
What to avoid or check alongside
- Other medicines that can harm the kidneys, such as some other antibiotics, water tablets and certain painkillers, add to the risk and call for closer monitoring.
- Drugs that can damage hearing, used alongside these antibiotics, increase the chance of hearing problems.
- Infusing vancomycin too fast brings on flushing and the red rash, which is why the drip rate is kept slow.
- Blood-level monitoring is central, as the gap between too little and too much is narrow with these medicines.
- Oral vancomycin acts only in the gut for C. difficile, so it is not interchangeable with the injected form used for infections elsewhere in the body.
Patient & carer advice
- You will have blood tests to keep the level right and protect your kidneys
- Tell us about any change in hearing or ringing in the ears
- If you are given oral vancomycin for a gut infection, finish the whole course as directed
Use with
Related clinical calculators
Dose and risk decisions for this class often depend on renal function, weight or bleeding/stroke risk. These tools help:
Answers
Glycopeptide antibiotics: frequently asked questions
What are glycopeptide antibiotics used for?
They treat serious infections caused by certain Gram-positive bacteria, including resistant ones such as MRSA. Examples are vancomycin and teicoplanin, given into a vein in hospital. They are often chosen when penicillin-type antibiotics cannot be used or are not effective against the bug causing the infection.
Why do I need blood tests on vancomycin?
The level of vancomycin in the blood must be kept in a fairly narrow range. Too little and the infection is not cleared, too much and it can harm the kidneys and hearing. Regular blood tests let the team adjust the dose to keep treatment both safe and effective, alongside checks on kidney function.
What is red man syndrome?
It is a flushing and red rash, often on the face, neck and upper body, that can happen if vancomycin is run into the vein too quickly. It is not a true allergy and settles when the drip is slowed down. This is why vancomycin is always infused slowly rather than given in a rush.
Why is vancomycin sometimes given as tablets?
Vancomycin taken by mouth stays in the bowel and is not absorbed into the body, so it is used specifically to treat a gut infection called C. difficile. Because it does not get into the bloodstream, it cannot treat infections elsewhere, which are treated with the drip form instead.
Can these antibiotics affect my hearing or kidneys?
Yes, at high levels or alongside other medicines that have the same effect, they can affect the kidneys and hearing. This is why blood levels and kidney function are monitored during treatment. Tell the team about any new ringing in the ears, hearing changes or reduced urine so your dose can be reviewed.
Authoritative sources
Always verify against the source
This overview is for orientation. For doses, interactions, contra-indications and the full monograph, use:
Related guides
Medicines in this class
Common glycopeptide antibiotics by active ingredient
Individual, dose-free guides to specific medicines in this class:
Browse by body system
Part of the infections
See all the conditions, medicine classes and active-ingredient guides for this body system in one place:
Need a custom medicines or prescribing resource?
We build evidence-led clinical references, calculators and decision aids for teams.