Three-times weekly teicoplanin in the outpatient treatment of acute methicillin-resistant staphylococcal osteomyelitis: a pilot study.
Treatment of osteomyelitis requires prolonged hospital stay, lengthy antibiotic therapy and adequate surgical debridement. Outpatient parenteral antibiotic therapy (OPAT) is a new approach to reduce patient discomfort and hospital costs. Teicoplanin, a glycopeptide antibiotic with a long half-life (72 hours), is one of the most useful drugs for OPAT. We performed a pilot study to assess the safety and efficacy of three-times weekly teicoplanin in the treatment of methicillin-resistant (MR) acute staphylococcal osteomyelitis. Ten patients with acute post-traumatic osteomyelitis were enrolled. Pathogens were MR Staphylococcus aureus (5 patients) and MR coagulase-negative staphylococci (5 patients). After a loading dose of 400 mg b.i.d. for 3 days, patients were treated with an intravenous dose of 1000 mg on Mondays and Wednesdays and with a 1200 mg dose on Fridays. Teicoplanin trough levels were maintained within a 10 to 20 mg/L range. If hardware removal had been possible at enrollment, treatment was carried out for at least 4 weeks. If, on the contrary, hardware removal had not been possible, teicoplanin was administered as suppressive therapy until hardware removal. Treatment was successfully performed in 9 out of 10 patients, whereas in one patient only improvement was achieved. Side effects were not recorded. Three times weekly teicoplanin seems to be a valuable option in the treatment of acute MR staphylococcal osteomyelitis. Further studies are warranted in order to better define the role of this new administration schedule in this field.
Lazzarini
L
L
Department of Infectious and Tropical Diseases, Ospedale S. Bortolo, Vicenza, Italy. fdl.vi@gpnet.it
Tramarin
A
A
Bragagnolo
L
L
Tositti
G
G
Manfrin
V
V
de
Lalla F
LF
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017046:Cost Savings; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy*; D010045:Outpatients; D010865:Pilot Projects; D013203:Staphylococcal Infections / Q000188:drug therapy*; D017334:Teicoplanin / Q000008:administration & dosage*
D000900:Anti-Bacterial Agents; D017334:Teicoplanin