Teicoplanin versus vancomycin in the empirical treatment of febrile neutropenic patients.
Gram-positive infections have become prevalent among neutropenic patients with cancer. A prospective, randomized, double-blind trial of teicoplanin, 6 mg/kg every 12 h for three doses then every 24 h, versus vancomycin hydrochloride, 15 mg/kg every 12 h, in the empirical treatment of febrile neutropenic patients was undertaken among 50 consecutive patients with haematological malignancy. The patients also received piperacillin sodium, 3 g every 4 h, and tobramycin sulphate, 1.5-2 mg/kg every 8 h. Both groups (25 teicoplanin and 25 vancomycin) were comparable in age, sex, renal function, underlying disease and concurrent therapy. Among 22 patients (44%) with culture-proven infection, Gram-positive organisms were isolated in 15 (9 with bacteraemia) and Gram-negative in 11 (4 with bacteraemia). Mixed or polymicrobial infection occurred in 8 patients. Serum 1-h peak and trough levels at steady state were 41 +/- 15 and 12 +/- 3 mg/l for teicoplanin (at 14 +/- 4 days), and 40 +/- 10 and 8 +/- 5 mg/l for vancomycin (at 0.9 +/- 0.6 days). Mean elimination half-life and apparent volume of distribution at steady state were 80.5 +/- 21.5 h and 1.4 +/- 0.8 l/kg for teicoplanin, and 5.6 +/- 1.8 h and 0.6 +/- 0.2 l/kg for vancomycin. Empirical antimicrobial therapy was successful in 23 teicoplanin and 21 vancomycin patients, respectively (p = 0.67; two-tailed Fisher's exact test). Nephrotoxicity (serum creatinine > 110 mmol/l), however, was more common among vancomycin patients (10 versus 2; p = 0.02), while termination of treatment due to adverse effects was also more common among vancomycin patients (10 versus 2; p = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
Chow
A W
AW
Division of Infectious Diseases, University of British Columbia, Vancouver, Canada.
Jewesson
P J
PJ
Kureishi
A
A
Phillips
G L
GL
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D002405:Catheterization, Central Venous; D002408:Catheters, Indwelling; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D005334:Fever / Q000382:microbiology*; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D007674:Kidney Diseases / Q000139:chemically induced; D007938:Leukemia / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications*; D010406:Penicillins / Q000627:therapeutic use; D015995:Prevalence; D011446:Prospective Studies; D018805:Sepsis / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D015163:Superinfection / Q000453:epidemiology / Q000209:etiology; D017334:Teicoplanin / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D014031:Tobramycin / Q000627:therapeutic use; D016896:Treatment Outcome; D014640:Vancomycin / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*
D000970:Antineoplastic Agents; D010406:Penicillins; D017334:Teicoplanin; D014640:Vancomycin; D014031:Tobramycin