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

Abstract

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 enrolment, 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.

Comparative Efficacy and Safety of Vancomycin versus Teicoplanin: Systematic Review and Meta-Analysis

“…1. The search yielded 269 publications, 61 of which were potentially eligible; and 24 individual randomized controlled trials comparing vancomycin versus teicoplanin fulfilled inclusion criteria (1,4,8,10,11,14,18,20,22,33,34,40,42,45,46,48,49,51,60,62,(71)(72)77).…”

Meta-analysis of Randomized Controlled Trials of Vancomycin for the Treatment of Patients With Gram-Positive Infections: Focus on the Study Design

“…77 In trials studying febrile neutropenic patients, vancomycin and comparator antibiotics were included in the first-line empirical regimen in 7 trials, 32,54,61,62,64,67,69 in 2 trials they were administered after treatment failure of the initial regimen (usually a ␤-lactam with or without an aminoglycoside) was encountered, 59,71 and in the remaining 3 randomization was performed after the VANCOMYCIN FOR GRAM-POSITIVE INFECTIONS: A META-ANALYSIS isolation of gram-positive cocci. 55,57,73 Finally, 1 trial did not report the time of randomization. 66 Patients with concomitant gram-negative or mixed infections were treated with appropriate regimens (mainly aztreonam or other ␤-lactams and aminoglycosides).…”

“…a These numbers correspond to 2 different randomized controlled trials that were published as one in Clinical Infectious Diseases. 50 45 2005 Corey et al, 39 2010 D'Antonio et al, 55 2004 Florescu et al, 44 2008 Gilbert et al, 72 1991 Jaksic et al, 32 2006 Kureishi et al, 69 1991 Lin et al, 27 2008 Noel et al, 43 2008 Noel et al, 42 2008 Rolston et al, 66 1994 Rolston et al, 58 1999 Rubinstein et al, 38 2001 Rubinstein et al, 50 2011 (0015) …”

Bacteremia in Patients with Hematological Malignancies

“…The most commonly used 2-drug combination therapy included an aminoglycoside plus antipseu- [23,24] . Because of the emergence of vancomycin-resistant enterococci associated with an excessive use of vancomycin, the use of vancomycin in most febrile granulocytopenic patients should be limited to those with infections due to methicillin-resistant staphylococci or to susceptible grampositive bacteria not responding to initial therapy [25] . The choice of empirical antibiotics must be individualized at each institution.…”