30 th May What you didn’t know about the antibiotic vancomycin
What you didn’t know about the antibiotic vancomycin:
In recent news, we hear about the the antibiotic vancomycin. In an effort to help fight the threat of antibiotic-resistant infections, researchers at The Scripps Research Institute (TSRI) have modified the treatment to make it more potent against bacteria, dubbing its effects ‘magical’. But where did it all start for vancomycin?
The birth of vancomycin:
In 1952, a missionary in Borneo sent a sample of dirt to his friend Dr. E. C. Kornfield, an organic chemist at Eli Lilly. An organism isolated from that sample (Streptomyces orientalis) produced a substance (“compound 05865”) that was active against penicillin-resistant pathogens including staphylococci, clostridia and Neisseria gonorrhoeae.
Dubbed “Mississippi mud” because of its brown colour, the compound needed to be purified before its application in clinical trials. A switch from picric acid precipitation to passage over an ion-exchange resin resulted in a drug suitable for clinical trials. Because of this process, it was named “vancomycin” (from the word “vanquish”).
But vancomycin therapy was not without side effects. During clinical trials, there was a therapy failure in a patient who was admitted to hospital with multiple complications, including shock and intractable heart failure, and who died after receiving vancomycin treatment. It is now understood that side effects from the drug in the early clinical trials including vestibular and renal, were most likely due to impurities contained in early vancomycin lots. Notwithstanding, the clinical trials yielded a high success rate which led to approval by the FDA in 1958. Later studies confirmed the efficacy of the drug but not before these side effects had generated a perceived sense of toxicity associated with vancomycin therapy. So, when methicillin, the first semisynthetic penicillin (which was considered to be less toxic and equally or more efficacious than vancomycin) was also approved in 1958, it quickly became the preferred treatment over vancomycin. Vancomycin became reserved for only those patients with serious b-lactam allergies or patients with infections caused by organisms that were resistant to the newer agents.
Over time, further efficacy and safe toxicity studies put vancomycin back in the spotlight and by the early 1980’s the use of vancomycin was quickly and widely accelerated. Inevitably, by the end of that decade, vancomycin resistance had already begun to occur. Read more about how recent scientific modifications to the drug has made it more 1000 times more powerful than the original here.