Infective endocarditis and glycopeptides.
BACKGROUND
Despite the number of antibacterial agents currently available, endocarditis remains a difficult disease to treat and the mortality rate has not fallen in recent years. The glycopeptides have good activity against the Gram-positive bacteria commonly implicated in endocarditis (staphylococci, both coagulase-positive and negative; enterococci and streptococci).


OBJECTIVE
To assess the impact of the glycopeptides vancomycin and teicoplanin on the therapy of infectious endocarditis caused by Gram-positive bacteria.


METHODS
A retrospective review of all major published or recently conducted studies using vancomycin or teicoplanin to treat endocarditis.


RESULTS
Cure rates obtained with vancomycin and teicoplanin are similar, but there are no controlled studies to investigate this. Vancomycin nephrotoxicity limits its use in endocarditis, in particular when used in combination with an aminoglycoside. By contrast, teicoplanin shows little nephrotoxic potential, even in patients with some degree of renal impairment or when given in combination with an aminoglycoside. Teicoplanin should be used at doses of 6 mg/kg/day or higher to achieve satisfactory cure rates.


CONCLUSIONS
Clinical data on the use of glycopeptides in endocarditis suffer from a lack of controlled trials. Although teicoplanin appears to offer some advantages over vancomycin in the therapy of endocarditis, there is an urgent need for randomized, clinical trials before definitive conclusions can be drawn.
Pittet
D
D
Department of Internal Medicine, University Hospital of Geneva, Switzerland.
Harding
I
I
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D004697:Endocarditis, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy*; D006801:Humans; D012189:Retrospective Studies; D017334:Teicoplanin / Q000627:therapeutic use*; D014640:Vancomycin / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D017334:Teicoplanin; D014640:Vancomycin