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. 1990 Sep;34(9):1642–1647. doi: 10.1128/aac.34.9.1642

Application of a modified bioassay for monitoring serum teicoplanin and vancomycin in febrile neutropenic patients.

A Kureishi 1, P J Jewesson 1, K H Bartlett 1, C D Cole 1, A W Chow 1
PMCID: PMC171898  PMID: 2149492

Abstract

Teicoplanin is a glycopeptide antibiotic with a mode of action and spectrum of activity similar to those of vancomycin. Its efficacy and tolerability as empiric therapy and its pharmacokinetic properties in neutropenic patients are being studied in a double-blinded, randomized trial in comparison with those of vancomycin. We report here a modified agar diffusion bioassay which is suitable for monitoring levels of either teicoplanin or vancomycin in serum during combination therapy with beta-lactams, aminoglycosides, and amphotericin B. Serum samples spiked with either teicoplanin or vancomycin gave reproducible results (mean coefficient of variation, 8.8%) regardless of the presence of tobramycin, amikacin, piperacillin, ceftazidime, amphotericin B, or their combinations. Among 25 patients who received teicoplanin at a dosing schedule of 6 mg/kg every 24 h intravenously, steady state was reached after 14.2 +/- 4.0 days, and 1-h peak and trough concentrations of teicoplanin in serum at steady state were 40.8 +/- 15.0 and 12.5 +/- 3.2 mg/liter, respectively. In contrast, among 25 patients who received vancomycin at a dosing schedule of 15 mg/kg every 12 h intravenously, steady state was reached by 24 h, and the 1-h peak and trough concentrations in serum were 37.5 +/- 15.6 and 8.3 +/- 3.8 mg/liter, respectively. The elimination half-lives for teicoplanin estimated by two separate approaches agreed closely with each other: 80.5 +/- 21.5 h by an accumulation model (M. Gilbaldi and D. Perrier, Pharmacokinetics, 2nd ed., p. 121, 1982) and 87.3 +/- 19.3 h as predicted from the degree of renal function (M. Rowland, Clin. Pharmacokinetic 18:184-209, 1990). These values were 14- to 15-fold higher than that for vancomycin (5.6 +/- 1.8 h). Since considerable variability was noted in the pharmacokinetic parameters for both teicoplanin and vancomycin among the individual patients, our data further emphasized the need for frequent monitoring of these drugs during empiric therapy of the febrile neutropenic patient.

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Selected References

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  1. Assandri A., Bernareggi A. Binding of teicoplanin to human serum albumin. Eur J Clin Pharmacol. 1987;33(2):191–195. doi: 10.1007/BF00544566. [DOI] [PubMed] [Google Scholar]
  2. Babul N., Pasko M. Teicoplanin: a new glycopeptide antibiotic complex. Drug Intell Clin Pharm. 1988 Mar;22(3):218–226. doi: 10.1177/106002808802200309. [DOI] [PubMed] [Google Scholar]
  3. Barry A. L., Thornsberry C., Jones R. N. Evaluation of teicoplanin and vancomycin disk susceptibility tests. J Clin Microbiol. 1986 Jan;23(1):100–103. doi: 10.1128/jcm.23.1.100-103.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bibler M. R., Frame P. T., Hagler D. N., Bode R. B., Staneck J. L., Thamlikitkul V., Harris J. E., Haregewoin A., Bullock W. E., Jr Clinical evaluation of efficacy, pharmacokinetics, and safety of teicoplanin for serious gram-positive infections. Antimicrob Agents Chemother. 1987 Feb;31(2):207–212. doi: 10.1128/aac.31.2.207. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Calain P., Krause K. H., Vaudaux P., Auckenthaler R., Lew D., Waldvogel F., Hirschel B. Early termination of a prospective, randomized trial comparing teicoplanin and flucloxacillin for treating severe staphylococcal infections. J Infect Dis. 1987 Feb;155(2):187–191. doi: 10.1093/infdis/155.2.187. [DOI] [PubMed] [Google Scholar]
  6. Carver P. L., Nightingale C. H., Quintiliani R., Sweeney K., Stevens R. C., Maderazo E. Pharmacokinetics of single- and multiple-dose teicoplanin in healthy volunteers. Antimicrob Agents Chemother. 1989 Jan;33(1):82–86. doi: 10.1128/aac.33.1.82. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Chambers H. F., Kennedy S. Effects of dosage, peak and trough concentrations in serum, protein binding, and bactericidal rate on efficacy of teicoplanin in a rabbit model of endocarditis. Antimicrob Agents Chemother. 1990 Apr;34(4):510–514. doi: 10.1128/aac.34.4.510. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cynamon M. H., Granato P. A. Comparison of the in vitro activities of teichomycin A2 and vancomycin against staphylococci and enterococci. Antimicrob Agents Chemother. 1982 Mar;21(3):504–505. doi: 10.1128/aac.21.3.504. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Del Favero A., Menichetti F., Guerciolini R., Bucaneve G., Baldelli F., Aversa F., Terenzi A., Davis S., Pauluzzi S. Prospective randomized clinical trial of teicoplanin for empiric combined antibiotic therapy in febrile, granulocytopenic acute leukemia patients. Antimicrob Agents Chemother. 1987 Jul;31(7):1126–1129. doi: 10.1128/aac.31.7.1126. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Domart Y., Pierre C., Clair B., Garaud J. J., Regnier B., Gibert C. Pharmacokinetics of teicoplanin in critically ill patients with various degrees of renal impairment. Antimicrob Agents Chemother. 1987 Oct;31(10):1600–1604. doi: 10.1128/aac.31.10.1600. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Erickson R. C., Hildebrand A. R., Hoffman P. F., Gibson C. B. A sensitive bioassay for teicoplanin in serum in the presence or absence of other antibiotics. Diagn Microbiol Infect Dis. 1989 May-Jun;12(3):235–241. doi: 10.1016/0732-8893(89)90020-5. [DOI] [PubMed] [Google Scholar]
  12. Karp J. E., Dick J. D., Angelopulos C., Charache P., Green L., Burke P. J., Saral R. Empiric use of vancomycin during prolonged treatment-induced granulocytopenia. Randomized, double-blind, placebo-controlled clinical trial in patients with acute leukemia. Am J Med. 1986 Aug;81(2):237–242. doi: 10.1016/0002-9343(86)90257-3. [DOI] [PubMed] [Google Scholar]
  13. Krogstad D. J., Moellering R. C., Jr, Greenblatt D. J. Single-dose kinetics of intravenous vancomycin. J Clin Pharmacol. 1980 Apr;20(4 Pt 1):197–201. doi: 10.1002/j.1552-4604.1980.tb01696.x. [DOI] [PubMed] [Google Scholar]
  14. Levy J., Truong B. L., Goignau H., Van Laethem Y., Butzler J. P., Bourdoux P. High pressure liquid chromatographic quantitation of teicoplanin in human serum. J Antimicrob Chemother. 1987 Apr;19(4):533–539. doi: 10.1093/jac/19.4.533. [DOI] [PubMed] [Google Scholar]
  15. Pallanza R., Berti M., Goldstein B. P., Mapelli E., Randisi E., Scotti R., Arioli V. Teichomycin: in-vitro and in-vivo evaluation in comparison with other antibiotics. J Antimicrob Chemother. 1983 May;11(5):419–425. doi: 10.1093/jac/11.5.419. [DOI] [PubMed] [Google Scholar]
  16. Patton K. R., Beg A., Felmingham D., Ridgway G. L., Grüneberg R. N. Determination of teicoplanin concentration in serum using a bioassay technique. Drugs Exp Clin Res. 1987;13(9):547–550. [PubMed] [Google Scholar]
  17. Pfaller M. A., Krogstad D. J., Granich G. G., Murray P. R. Laboratory evaluation of five assay methods for vancomycin: bioassay, high-pressure liquid chromatography, fluorescence polarization immunoassay, radioimmunoassay, and fluorescence immunoassay. J Clin Microbiol. 1984 Sep;20(3):311–316. doi: 10.1128/jcm.20.3.311-316.1984. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Pryka R. D., Rodvold K. A., Rotschafer J. C. Teicoplanin: an investigational glycopeptide antibiotic. Clin Pharm. 1988 Sep;7(9):647–658. [PubMed] [Google Scholar]
  19. Rowland M. Clinical pharmacokinetics of teicoplanin. Clin Pharmacokinet. 1990 Mar;18(3):184–209. doi: 10.2165/00003088-199018030-00002. [DOI] [PubMed] [Google Scholar]
  20. Schwenzer K. S., Wang C. H., Anhalt J. P. Automated fluorescence polarization immunoassay for monitoring vancomycin. Ther Drug Monit. 1983;5(3):341–345. doi: 10.1097/00007691-198309000-00017. [DOI] [PubMed] [Google Scholar]
  21. Smith S. R., Cheesbrough J., Spearing R., Davies J. M. Randomized prospective study comparing vancomycin with teicoplanin in the treatment of infections associated with Hickman catheters. Antimicrob Agents Chemother. 1989 Aug;33(8):1193–1197. doi: 10.1128/aac.33.8.1193. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Verbist L., Tjandramaga B., Hendrickx B., Van Hecken A., Van Melle P., Verbesselt R., Verhaegen J., De Schepper P. J. In vitro activity and human pharmacokinetics of teicoplanin. Antimicrob Agents Chemother. 1984 Dec;26(6):881–886. doi: 10.1128/aac.26.6.881. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Walker C. A., Kopp B. Sensitive bioassay for vancomycin. Antimicrob Agents Chemother. 1978 Jan;13(1):30–33. doi: 10.1128/aac.13.1.30. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Williams A. H., Grüneberg R. N. Teicoplanin revisited. J Antimicrob Chemother. 1988 Oct;22(4):397–401. doi: 10.1093/jac/22.4.397. [DOI] [PubMed] [Google Scholar]

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