[The use of teicoplanin in neutropenic patients: values and limits].
The efficacy and the safety of teicoplanin were evaluated for the treatment of febrile episodes in neutropenic patients. A total of 18 patients received teicoplanin once daily as an intravenous injection of 200 mg in 6 patients (after a loading dose of 400 mg) or 400 mg in 12 patients (loading dose: 800 mg). The mean duration of therapy was 15.9 days (range 9 to 39 days). In all patients teicoplanin was combined with another antibiotic usually a beta-lactam. Thirteen of 18 patients were successfully treated. Three febrile episodes proved to be microbiologically documented infections and were cured by teicoplanin: one Streptococcus mitis and two methicillin-resistant (methi-R) Staphylococcus epidermidis bacteremias. Neither toxicity nor side effects were observed in the reported group. Six patients experiencing reactions to vancomycin (2 cases of cutaneous allergy) or to vancomycin and amphotericin B combination (4 cases of nephrotoxicity) were subsequently treated with teicoplanin without any evidence of cross-sensitivity. We observed emergence of teicoplanin-resistant coagulase-negative Staphylococcus in 3 patients receiving teicoplanin: 20, 18 and 8 days after a first febrile episode cured by teicoplanin and a beta-lactam, they developed fever while receiving the same antibiotic regimen. Methi-R Staphylococcus epidermidis was isolated from blood cultures in the first patient and methi-R Staphylococcus haemolyticus in the two other patients. In one patient, successfully treated by teicoplanin for a first febrile episode related to a methi-R Staphylococcus epidermidis, emergence of Staphylococcus haemolyticus occurred 8 days later while the patient was on teicoplanin therapy (6 mg/kg). MICs of teicoplanin were 16 mg/l for the two Staphylococcus strains isolated in this patient.(ABSTRACT TRUNCATED AT 250 WORDS)
Espinouse
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Service d'Hématologie Clinique, Centre Hospitalier Lyon-Sud, Pierre-Bénite.
Chomarat
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M
D000328:Adult; D000368:Aged; D000380:Agranulocytosis / Q000150:complications*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D004361:Drug Tolerance; D005334:Fever / Q000150:complications / Q000188:drug therapy*; D006020:Glycopeptides / Q000627:therapeutic use; D006094:Gram-Positive Bacteria; D006801:Humans; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications*; D017334:Teicoplanin
D000900:Anti-Bacterial Agents; D006020:Glycopeptides; D017334:Teicoplanin
Utilisation de la teicoplanine chez les patients neutropéniques: intérêts et limites.