Table 1 Approved indications and pharmacokinetic properties of vancomycin, linezolid, tigecycline and daptomycin [4, 25, 46, 70]

Approved Indications (FDA)

Serious or severe infections caused by susceptible strains of methicillin-resistant (beta-lactam-resistant) staphylococci.

Vancomycin-Resistant E. faecium infections

Complicated skin and skin structure infections.

Complicated skin and skin structure infections.

Alone or in combination with an aminoglycoside for endocarditis caused by S. viridans or S. bovis.

Nosocomial pneumonia caused by S. aureus or S. pneumoniae including multi-drug resistant strains

Complicated intra-abdominal infections.

S. aureus Bloodstream Infections (bacteremia), including those with right-sided infective endocarditis, caused by methicillin-susceptible and methicillin-resistant isolates.

For endocarditis caused by enterococci (e.g., E. faecalis) only in combination with an aminoglycoside.

Complicated skin and skin structure infections, including diabetic foot infections

Community-acquired bacterial pneumonia

Uncomplicated skin and skin structure infections caused by MSSA or S. pyogenes.

Community-acquired pneumonia caused by MSSA

Oral Bioavailability

Not absorbed

Not absorbed

Not absorbed

Completely absorbed

Clearance

0.06 L/h/kg

0.01 L/h/kg

0.33 L/h/kg

0.10 L/h/kg

Volume of Distribution

0.3 to 0.43 L/kg

0.1 L/kg

8-9 L/kg

0.7-0.8 L/kg

Half-Life

4-6 h

8 h

27-42 h

4-5 h

Protein Binding

90-93%

71-89%

Major Route of

renal

renal

biliary

metabolism

Elimination

30% renal

Tissue Penetration

moderate

low

very high

high

Usual Dosing Regimen

1000 mg IV over 60 min.

Q12h with Drug Level Monitoring

4-6 mg/kg IV over 30 min.

Q24h

50 mg IV over 30-60 min.

Q 12h First dose 100 mg IV

600 mg IV over 30-120 min.

Q12h 400-600 mg PO Q12h

Dosing in Renal Impairment

Increased Dosing Interval with Drug Level Monitoring

Increased Dosing Interval

No dose adjustment

No dose adjustment