Options and limitations of teicoplanin in febrile granulocytopenic patients.
During the years 1985-89 three studies on the efficacy and safety of teicoplanin in the treatment of febrile granulocytopenic patients suffering from haematological malignancies were assessed. In the first prospective study, teicoplanin at a dose of 400 mg/d was added to the initial empiric therapy of 65 febrile granulocytopenic episodes. When teicoplanin was given because of proven or presumed Gram-positive infection, 67% of cases were treated successfully. Patients with skin and soft-tissue infections achieved a 78% response rate. The second study on 120 patients was designed as a prospective randomized trial to compare the efficacy and toxicity of ceftazidime with and without teicoplanin. Response was achieved in 25/51 (49%) cases from the ceftazidime and in 33/52 cases (63%) from the combination groups. Seven of 18 (39%) cases with initial bacteraemia in the monotherapy group compared with 10/20 (50%) cases in the combination group responded to the empiric regimen. A retrospective analysis was carried out on the efficacy of teicoplanin in 125 cases of proven Gram-positive Hickman line-associated bacteraemia. Teicoplanin proved to be effective in eradicating 80% of the Staphylococcus epidermidis, 72% of the Staph. aureus, 90% of the 'viridans' streptococci and 67% of the enterococci. Removal of the catheter was required in 13% of cases in order to control the infection, and only one patient died of a catheter-related septicaemia caused by Staph. aureus. The total success rate leaving the catheter in situ was 78%, and 92% if cases with catheter removal were included. Serum levels of teicoplanin were predictable giving a peak and trough concentration on the fourth day of 30.4 +/- 5.0 mg/l and 9.8 +/- 1.7 mg/l. Hearing loss of 20 dB at 8000 Hz was noted in one case and transient liver or kidney disturbances attributable to the drug were observed in 4% of cases.
De Pauw
B E
BE
Department of Hematology, Nijmegen, The Netherlands.
Novakova
I R
IR
Donnelly
J P
JP
D000380:Agranulocytosis / Q000150:complications*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000188:drug therapy*; D002406:Catheterization, Peripheral / Q000009:adverse effects; D002442:Ceftazidime / Q000627:therapeutic use; D005334:Fever / Q000150:complications*; D006020:Glycopeptides / Q000627:therapeutic use; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006402:Hematologic Diseases / Q000150:complications; D006801:Humans; D011446:Prospective Studies; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy; D017334:Teicoplanin
D000900:Anti-Bacterial Agents; D006020:Glycopeptides; D017334:Teicoplanin; D002442:Ceftazidime