Addition of teicoplanin or vancomycin for the treatment of documented bacteremia due to gram-positive cocci in neutropenic patients with hematological malignancies: microbiological, clinical and economic evaluation.
A prospective, randomized, double-blind trial was conducted on 124 febrile patients with hematological malignancies to compare teicoplanin with vancomycin as an addition to the initial empiric amikacin-ceftazidime regimen after documented bacteremia due to gram-positive cocci. At enrollment, patients in both groups were comparable with respect to age, sex, underlying hematologic disorders and duration of neutropenia. Rates of therapeutic success were 55/63 (87.3%) in the teicoplanin group and 56/61 (91.8%) in the vancomycin group (p = 0.560). The mean duration of treatment was similar, being 12.2 and 11.4 days, respectively (p = 0.216). Patients treated with teicoplanin remained febrile for slightly longer than those treated with vancomycin (4.9 vs. 4.0 days) (p = 0.013). Thirteen patients experienced an adverse drug reaction, but without any significant difference in the two arms. Isolated staphylococci showed a progressive and significant decrease in susceptibility to both glycopeptides during the 8 study years. The economic analysis performed showed that the addition of vancomycin is cost-saving.
D'Antonio
D
D
Dipartimento di Ematologia e Medicina Trasfusionale, Ospedale Spirito Santo, Pescara, Italy. domenicodantonio@virgilio.it
Staniscia
T
T
Piccolomini
R
R
Fioritoni
G
G
Rotolo
S
S
Parruti
G
G
Di Bonaventura
G
G
Manna
A
A
Savini
V
V
Fiorilli
M P
MP
Di Giovanni
P
P
Francione
A
A
Schioppa
F
F
Romano
F
F
D000328:Adult; D016470:Bacteremia / Q000188:drug therapy* / Q000209:etiology; D017046:Cost Savings; D004311:Double-Blind Method; D004359:Drug Therapy, Combination / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D005334:Fever / Q000209:etiology; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000209:etiology; D006095:Gram-Positive Cocci / Q000187:drug effects*; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications / Q000188:drug therapy*; D011446:Prospective Studies; D017334:Teicoplanin / Q000191:economics / Q000627:therapeutic use*; D016896:Treatment Outcome; D014640:Vancomycin / Q000191:economics / Q000627:therapeutic use*
D017334:Teicoplanin; D014640:Vancomycin