title: Using teicoplanin for empiric therapy of febrile neutropenic patients with haematological malignancies.
abstract: The cumulative experience with teicoplanin in treating febrile neutropenic patients included in three different comparative clinical trials conducted at a single institution during a 3-year period, is presented. 152 febrile episodes in 129 neutropenic patients were treated with i.v. teicoplanin (6 mg/kg/d) combined with amikacin (15 mg/kg/d) plus ceftazidime (90 mg/kg/d). The study population comprised 75 patients with acute leukaemia and 77 marrow recipients: 53% (81/152) had a central venous catheter in place and 68% (103/152) had severe neutropenia (less than 100/mm3) at the beginning of the febrile episode. The overall response rate of the evaluable febrile episodes was excellent: 88% (107/122) improved. Bacteraemias due to Gram-positive cocci accounted for 75% of the total (42/56) and pathogens in the blood isolates were mostly staphylococci (coagulase-negative 14, coagulase-positive 13) and streptococci (13). The response rate of Gram-positive bacteraemias was good: 88% (37/42) improved and 75% (9/12) of Gram-positive bacteraemias having teicoplanin as the only antibiotic with in vitro activity against the infective strains were cured. Death due to infection accounted for 7% of total febrile episodes (11/152). Side effects were documented in 14% of the episodes. In a setting of high prevalence of Gram-positive infections caused by strains with a high rate of resistance to aminoglycoside and beta-lactam antibiotics, there may be an advantage in including teicoplanin in the initial empiric antibiotic regimen for febrile neutropenic cancer patients.
authors: Istituto di Malattie Infettive, Universitá di Perugia, Italy.
authors: F
authors: F
authors: Menichetti
authors: A
authors: A
authors: Del Favero
authors: G
authors: G
authors: Bucaneve
authors: F
authors: F
authors: Aversa
authors: M
authors: M
authors: Fiorio
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000583:Amikacin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000302:isolation & purification; D016026:Bone Marrow Transplantation / Q000276:immunology; D002442:Ceftazidime / Q000627:therapeutic use; D002648:Child; D004359:Drug Therapy, Combination; D005260:Female; D005334:Fever / Q000188:drug therapy* / Q000382:microbiology; D006020:Glycopeptides / Q000627:therapeutic use; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006801:Humans; D007938:Leukemia / Q000150:complications; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications*; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy; D017334:Teicoplanin
chemical_list: D000900:Anti-Bacterial Agents; D006020:Glycopeptides; D017334:Teicoplanin; D000583:Amikacin; D002442:Ceftazidime