High risk of cross-reactivity between vancomycin and sequential teicoplanin therapy

Vancomycin is one of the older antibiotics that has been now in clinical use close to 60 years. Earlier on, vancomycin was associated with many side effects including vestibular and renal, most likely due to impurities contained in early vancomycin lots. Over the years, the impurities have been removed and the compound has now far less vestibular adverse effects, but still possesses renal toxicity if administered at higher doses rendering trough serum levels of >15 mcg/mL or if administered for prolonged periods of time. Vancomycin is effective against most Gram-positive cocci and bacilli with the exception of rare organisms as well as enterococci that became vancomycin resistant, mostly Enterococcus faecium. The major use of vancomycin today is for infections caused by methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant Staphylococcus epidermidis (MRSE) and amoxicillin-resistant enterococci. In its oral form, vancomycin is used to treat diarrhea caused by Clsotridium difficile. With S. aureus, there are only a handful of vancomycin-resistant strains. Nevertheless, a “vancomycin creep” that is slow upward trending of vancomycin MIC from <1 mcg/mL to higher values has been noted in several parts of the world, but not globally, and strains that have MIC’s of 1.5–2 mcg/mL are associated with high therapeutic failure rates. This phenomenon has also been recently recognized in methicillin-susceptible S. aureus (MSSA). While vancomycin is relatively a safe agent adverse events include the “red man” syndrome, allergic reactions, and various bone marrow effects as well as nephrotoxicity. Vancomycin has been a very important tool in our therapeutic armamentarium that remained effective for many years, it is likely remain effective as long as resistance to vancomycin remains controlled.

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“…A cross allergic reaction between vancomycin and other glycopeptides has been described for teicoplanin but not for other glycopeptides (59). …”

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confidence: 99%

Vancomycin Revisited â€“ 60 Years Later

Rubinstein

Keynan

2014

Front. Public Health

147

133

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“…After coronary artery bypass graft surgery he developed sternal dehiscence and high-grade fever; his white blood cell count was 10,100/mL and Creactive protein was 8.8 mg/dL. While the sequential administration of teicoplanin after vancomycin-induced adverse drug reactions may increase the incidence of drug reactions elicited by teicoplanin due to the cross-reactivity of these drugs [2,6], our patient had not undergone prior treatment with vancomycin. His teicoplanin trough levels were monitored to stay within the therapeutic range (10-20 mg/mL).…”

Section: Teicoplanin-induced Purpuric Eruption With Leukocytoclastic mentioning

confidence: 87%

“…In 1992, Ruiz-Maldonado et al proposed diagnostic criteria for HI [2]. nervous and/or musculoskeletal abnormalities [2]. nervous and/or musculoskeletal abnormalities [2].…”

Section: Pigmentary Mosaicism Of the Hypopigmented Type (Hypomelanosimentioning

confidence: 99%

“…It is typically characterized by more than two hypopigmented segments with extracutaneous manifestations, i.e. Most patients have linear unilateral or bilateral lesions but patchy lesions may also occur [2]. Most patients have linear unilateral or bilateral lesions but patchy lesions may also occur [2].…”

Section: Pigmentary Mosaicism Of the Hypopigmented Type (Hypomelanosimentioning

confidence: 99%

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Teicoplanin-induced purpuric eruption with leukocytoclastic vasculitis

Uchida

Higashi

Kanekura

2014

European Journal of Dermatology

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689 clinical and histopathological features in our case would be a spectrum of the most progressed form, which might initially have developed as either PXE-like PDE or WFPN. We believe that FEP is crucial concept for unifying PXElike PDE, WFPN and overlapping conditions, including our advanced case with a long-lasting history. Naoki OISOMaiko KATO Akira KAWADA 1. Rongioletti F, Izakovic J, Romanelli P, Lanuti E, Miteva M. Pseudoxanthoma elasticume-like papillary dermal elastolysis: A large case series with clinicopathological correlation. LY. Fibrillin immunoreactive fibers constitute a unique network in the human dermis: immunohistochemical comparison of the distributions of fibrillin, vitronectin, amyloid P component, and orcein stainable structures in normal skin and elastosis. J Invest Dermatol 1990; 94: 284-91. 10. Revelles JM, Machan S, Pielasinski U, et al. Pseudoxanthoma elasticum-like papillary dermal elastolysis: immunohistochemical study using elastic fiber cross-reactivity with an antibody against amyloid P component.

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“…Previous studies have reported that the alternate use of TEC in cases of VAN intolerance was associated with a high incidence of drug-related adverse events, most notably neutropenia (36,37). Therefore, the potential cross-reactivity between these 2 glycopeptides remains to be clarified in future studies.…”

Section: Discussionmentioning

confidence: 99%

Multicenter Prospective Observational Study of the Comparative Efficacy and Safety of Vancomycin versus Teicoplanin in Patients with Health Care-Associated Methicillin-Resistant Staphylococcus aureus Bacteremia

Yoon

Park²,

Kim

et al. 2014

Antimicrob Agents Chemother

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pThe purpose of this study was to compare the clinical efficacy and safety of vancomycin to those of teicoplanin for the treatment of adult patients with health care-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) bacteremia. A multicenter observational study was prospectively conducted in 15 teaching hospitals in Korea between February 2010 and July 2011. Adult patients (>18 years old) with HA-MRSA bacteremia who were initially treated with vancomycin (VAN) (n ‫؍‬ 134) or teicoplanin (TEC) (n ‫؍‬ 56) were enrolled. Clinical and microbiological responses and drug-related adverse events were compared between the two treatment groups using univariate and multivariate logistic regression analyses. The vancomycin and teicoplanin MICs were determined by Etest. The MRSA-related mortality, duration of fever, and duration of MRSA bacteremia in the treatment groups were not significantly different. There was no significant difference in the occurrence of drug-related adverse events. Among the 190 MRSA isolates, the VAN MICs ranged from 0.5 to 2 g/ml (MIC 50 and MIC 90 , 1.5 g/ml), and the TEC MIC ranged from 0.5 to 8 g/ml (MIC 50 , 3 g/ml; MIC 90 , 6 g/ml). In multivariate analyses, the antibiotic type (vancomycin or teicoplanin) was not associated with treatment outcomes. This study indicates that teicoplanin is an effective and safe alternative to vancomycin for the treatment of HA-MRSA bacteremia.

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High risk of cross-reactivity between vancomycin and sequential teicoplanin therapy

Abstract: Teicoplanin, used as an alternative in cases of vancomycin intolerance, was associated with a high incidence of ADRs and haematological reactions, most notably neutropenia. This high rate of ADRs suggests cross-reactivity between the two glycopeptides.

Cited by 20 publications

References 33 publications

Vancomycin Revisited â€“ 60 Years Later

Vancomycin Revisited â€“ 60 Years Later

Teicoplanin-induced purpuric eruption with leukocytoclastic vasculitis

Multicenter Prospective Observational Study of the Comparative Efficacy and Safety of Vancomycin versus Teicoplanin in Patients with Health Care-Associated Methicillin-Resistant Staphylococcus aureus Bacteremia

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