title: Oral Teicoplanin as an Alternative First-Line Regimen in Clostridium difficile Infection in Elderly Patients: A Case Series.
abstract: BACKGROUND
  Elderly patients are more susceptible to Clostridium difficile infections (CDIs). Despite existing guidelines, there is no specific treatment for CDI in geriatrics. Vancomycin is commonly used in the treatment of CDI. Teicoplanin is an alternative glycopeptide which recently received marketing authorization approval for CDI in Europe.
  
  
  OBJECTIVE
  Evaluate the potential interest of oral teicoplanin and assess whether such treatment could potentially become an alternative treatment in mild to severe CDIs in elderly patients.
  
  
  METHODS
  A prospective monocentric study was conducted over 10 months (from December 2015 to October 2016) in a geriatric unit (Sainte Périne, AP-HP, Paris, France). According to the remote infectious disease specialist, some hospitalized patients suffering from CDI and aged over 65 years received oral teicoplanin 200 mg twice a day (highest dose recommended). The clinical response to teicoplanin and relapses after treatment were evaluated. Patients were monitored up to 90 days after teicoplanin administration, and analyzed in non-responder imputation analysis.
  
  
  RESULTS
  Eleven patients received teicoplanin among 19 CDIs during the study time period. In non-responder imputation analysis, 90.9% (n = 10) successfully responded to oral teicoplanin. The rate of relapse observed after a 90-day follow-up was 36.4%. Patients reported no drug-related adverse effects.
  
  
  CONCLUSIONS
  Oral teicoplanin is a glycopeptide that could be proposed as an alternative to other recommended drugs for CDI. In our case series, teicoplanin seems to be an effective therapy as a first-line regimen for CDI in geriatrics. Such treatment has good acceptability in geriatrics, considering it can be taken orally twice a day.
authors.affiliation: Maladies Infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380, Garches, France. benjamin.davido@aphp.fr.
authors.forename: Benjamin
authors.identifier: http://orcid.org/0000-0002-2859-8417
authors.initials: B
authors.lastname: Davido
authors.affiliation: Pharmacie Hospitalière, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380, Garches, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Leplay
authors.affiliation: Pharmacie Hospitalière, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380, Garches, France.
authors.forename: Frédérique
authors.initials: F
authors.lastname: Bouchand
authors.affiliation: Maladies Infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380, Garches, France.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Dinh
authors.affiliation: Pharmacie Hospitalière, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380, Garches, France.|Pharmacie Hospitalière, Hôpital Universitaire Sainte-Périne, AP-HP, 75016, Paris, France.
authors.forename: Maryvonne
authors.initials: M
authors.lastname: Villart
authors.affiliation: Médecine Gériatrique, Hôpital Universitaire Sainte-Périne, AP-HP, 75016, Paris, France.
authors.forename: Jean-Laurent
authors.initials: JL
authors.lastname: Le Quintrec
authors.affiliation: Médecine Gériatrique, Hôpital Universitaire Sainte-Périne, AP-HP, 75016, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Teillet
authors.affiliation: Maladies Infectieuses, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380, Garches, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Salomon
authors.affiliation: Pharmacie Hospitalière, Hôpital Universitaire Raymond-Poincaré, AP-HP, 92380, Garches, France.|Pharmacie Hospitalière, Hôpital Universitaire Sainte-Périne, AP-HP, 75016, Paris, France.
authors.forename: Hugues
authors.initials: H
authors.lastname: Michelon
mesh_terms: D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016360:Clostridioides difficile / Q000187:drug effects*; D003015:Clostridium Infections / Q000188:drug therapy*; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D017334:Teicoplanin / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D017334:Teicoplanin