In vitro activities of vancomycin and teicoplanin against coagulase-negative staphylococci isolated from neutropenic patients

Maugein, J.; Pellegrin, J.L.; Brossard, G.; Fourche, J.; Leng, B; Reiffers, Josy

doi:10.1128/aac.34.5.901

Cited by 41 publications

(27 citation statements)

References 13 publications

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“…Not seen in the present study, emergence of low-level resistance (MIC, 8 to 16 mg/liter) has been reported for S. epidermidis (6,12), although the clinical significance of this remains to be established. In conclusion, the two regimens (vancomycin and teicoplanin) were not statistically different in the treatment of infections due to gram-positive bacteria for the number of patients studied.…”

Section: Discussionmentioning

confidence: 57%

“…Among the six clinical failures (Table 3) treated with a glycopeptide alone, three had persistent positive blood cultures (days 6, 10, and 15); two of these were sterilized with the addition of co-trimoxazole or a shift to oxacillin plus rifampin. In two other patients who failed, recurrence occurred 12 tively. None of the failures was due to the emergence of a resistant pathogen.…”

Section: Xmentioning

confidence: 99%

See 1 more Smart Citation

Randomized study of vancomycin versus teicoplanin for the treatment of gram-positive bacterial infections in immunocompromised hosts

Auwera

Aoun

Meunier

1991

Antimicrob Agents Chemother

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Seventy-four immunocompromised patients with severe infection due to gram-positive organisms were randomized to receive either vancomycin or teicoplanin. Extensive cancer was present in 71 patients, of whom 47 died within a month. The types of infections were 46 bacteremias (39 associated with central catheters), 24 skin and soft tissue infections (3 with bacteremia), and 7 others (mainly bronchopneumonia). Gram-positive bacteria have recently become the leading pathogens in cancer patients whether granulocytopenic or not. Several factors may contribute to this situation in granulocytopenic patients (25). More aggressive anticancer treatments have been associated with an increased incidence and severity of mucositis; in addition, the recurrence of oral herpes simplex has increased and represents a risk factor for bacteremia due to oral streptococci (15). The widespread use of gut decontamination with antimicrobial agents which are preferentially active against gram-negative bacilli has been associated with a decrease in rapidly fatal gram-negative bacillus infections. In addition, the frequently used longterm intravascular accesses, including implantable catheters (Port-a-Cath, Hickman, Broviac), are major sources of infection caused by gram-positive cocci. Moreover, grampositive bacteria usually proliferate from endogenous sources and various potential sites have been recognized, such as the skin (and possibly the gut) for coagulase-negative staphylococci, the oral mucosa for viridans group streptococci, and the gut for enterococci and some Streptococcus anginosus strains. The widespread incidence of oxacillinresistant coagulase-negative staphylococci renders the empirical use of oxacillin obsolete for nosocomial infections; vancomycin seems to be as effective as oxacillin against oxacillin-susceptible Staphylococcus aureus (3). Therefore, in most situations vancomycin is now considered the drug of choice for the treatment of proven or suspected grampositive bacteremia. However, vancomycin is potentially nephrotoxic and drug monitoring of concentrations in serum is recommended. Vancomycin is rather poorly tolerated and needs to be administered by the intravenous (i.v.) route; tissue irritation does not allow intramuscular use. Teicoplanin is a glycopeptide closely related to vancomycin, with a similar spectrum of activity (24), which seems less toxic at * Corresponding author. daily doses of .800 mg (6 to 12 mg/kg of body weight) (1, 5,18,21,26). The optimal dosage of teicoplanin has been controversial for several years. During the first clinical studies with 200-mg daily doses (3 mg/kg) (1, 2, 5), failures (including persisting or breakthrough bacteremia) were attributed to suboptimal dosing and unpredictable concentrations in serum (2, 5). Our preliminary open study (5) showed encouraging data with teicoplanin; therefore, the purpose of the present study was to compare the clinical results of a prospective randomized comparative study of vancomycin versus teicoplanin for documented gram-positive bacterial inf...

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Section: Discussionmentioning

confidence: 57%

Section: Xmentioning

confidence: 99%

Randomized study of vancomycin versus teicoplanin for the treatment of gram-positive bacterial infections in immunocompromised hosts

Auwera

Aoun

Meunier

1991

Antimicrob Agents Chemother

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“…In contrast, 78% of selected S. epidermidis isolates from Hungary, Spain, and Switzerland were trimethoprim resistant, but the majority (70%) of these isolates were methicillin susceptible (19 ,ug/ml) in one study (14). Both vancomycin and teicoplanin resistance can be easily selected in vitro in S. haemolyticus by exposure of isolates to either vancomycin or teicoplanin (56,65), yet only teicoplanin resistance can be generated for S. epidermidis by stepwise exposure of this species to glycopeptides (17). S. haemolyticus isolates recovered from patients receiving vancomycin have shown decreases in vancomycin susceptibility when compared to pretherapy isolates (66,81).…”

Section: Trimethoprimmentioning

confidence: 99%

Antimicrobial susceptibility of coagulase-negative staphylococci

Archer

Climo

1994

Antimicrob Agents Chemother

200

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“…Like vancomycin, it is active against most gram-positive organisms (18,(20)(21)(22)32), but it offers several potential advantages over vancomycin, including low toxicity, better tolerance after intravenous (i.v.) or intramuscular administration, and a longer elimination halflife (up to 15 times that of vancomycin) (2,5,16,26).…”

mentioning

confidence: 99%

Double-blind comparison of teicoplanin versus vancomycin in febrile neutropenic patients receiving concomitant tobramycin and piperacillin: effect on cyclosporin A-associated nephrotoxicity

Kureishi

Jewesson

Rubinger

et al. 1991

Antimicrob Agents Chemother

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A prospective, randomized, and double-blind study comparing teicoplanin with vancomycin in the initial management of febrile neutropenic patients was conducted. Teicoplanin was administered at 6 mg per kg of body weight every 24 h (q24h) intravenously (i.v.) after initial loading at 6 mg/kg ql2h for three doses. Vancomycin was administered at 15 mg/kg ql2h i.v. Patients also received piperacillin (3 g q4h i.v.) and tobramycin (1.5 to 2.0 mg/kg q8h i.v.). Of 53 patients enrolled, 50 were judged to be evaluable. Among these, 25 received teicoplanin and 25 received vancomycin. At enrollment, both groups were comparable in age, sex, renal function, underlying hematologic condition, and concurrent therapy. Both groups had similar sites of infection and microbial pathogens. Empirical antimicrobial therapy resulted in the cure of or improvement in 23 (92%) teicoplanin patients and 21 (84%) vancomycin patients (P = 0.67). Failures occurred with two vancomycin patients but no teicoplanin patients. Clinical response was indeterminate for two patients in each group. Adverse reactions occurred significantly more often in the vancomycin group than in the teicoplanin group (P = 0.01), and these reactions required the termination of the study regimens of 6 vancomycin versus 0 teicoplanin patients (P = 0.02). Nephrotoxicity was observed more frequently in the vancomycin group (10 versus 2 patients; P = 0.02). Subgroup analysis revealed a significant deterioration of renal function when vancomycin and cyclosporin A, but not teicoplanin and cyclosporin A, were used concurrently (P = 0.02). Among patients who received vancomycin and amphotericin B or teicoplanin and amphotericin B concurrently, deterioration in renal function was equivalent in both groups. Teicoplanin in the dosage employed was tolerated better than vancomycin in the empirical treatment of fever and neutropenia in our patient population.

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In vitro activities of vancomycin and teicoplanin against coagulase-negative staphylococci isolated from neutropenic patients

Abstract: This study reports

Cited by 41 publications

References 13 publications

Randomized study of vancomycin versus teicoplanin for the treatment of gram-positive bacterial infections in immunocompromised hosts

Randomized study of vancomycin versus teicoplanin for the treatment of gram-positive bacterial infections in immunocompromised hosts

Antimicrobial susceptibility of coagulase-negative staphylococci

Double-blind comparison of teicoplanin versus vancomycin in febrile neutropenic patients receiving concomitant tobramycin and piperacillin: effect on cyclosporin A-associated nephrotoxicity

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