Skip to main content
PMC home page
Antimicrobial Agents and Chemotherapy logoLink to Antimicrobial Agents and Chemotherapy
. 1991 Nov;35(11):2246–2252. doi: 10.1128/aac.35.11.2246

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

A Kureishi 1, P J Jewesson 1, M Rubinger 1, C D Cole 1, D E Reece 1, G L Phillips 1, J A Smith 1, A W Chow 1
PMCID: PMC245367  PMID: 1839490

Abstract

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 q12h for three doses. Vancomycin was administered at 15 mg/kg q12h 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.

Full text

PDF
2246

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aubert G., Passot S., Lucht F., Dorche G. Selection of vancomycin- and teicoplanin-resistant Staphylococcus haemolyticus during teicoplanin treatment of S. epidermidis infection. J Antimicrob Chemother. 1990 Mar;25(3):491–493. doi: 10.1093/jac/25.3.491. [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. Brunet F., Vedel G., Dreyfus F., Vaxelaire J. F., Giraud T., Schremmer B., Monsallier J. F. Failure of teicoplanin therapy in two neutropenic patients with staphylococcal septicemia who recovered after administration of vancomycin. Eur J Clin Microbiol Infect Dis. 1990 Feb;9(2):145–147. doi: 10.1007/BF01963643. [DOI] [PubMed] [Google Scholar]
  4. 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]
  5. Calain P., Waldvogel F. Clinical efficacy of teicoplanin. Eur J Clin Microbiol Infect Dis. 1990 Feb;9(2):127–129. doi: 10.1007/BF01963637. [DOI] [PubMed] [Google Scholar]
  6. 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]
  7. Cockcroft D. W., Gault M. H. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31–41. doi: 10.1159/000180580. [DOI] [PubMed] [Google Scholar]
  8. Farber B. F., Moellering R. C., Jr Retrospective study of the toxicity of preparations of vancomycin from 1974 to 1981. Antimicrob Agents Chemother. 1983 Jan;23(1):138–141. doi: 10.1128/aac.23.1.138. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Goldstein F. W., Coutrot A., Sieffer A., Acar J. F. Percentages and distributions of teicoplanin- and vancomycin-resistant strains among coagulase-negative staphylococci. Antimicrob Agents Chemother. 1990 May;34(5):899–900. doi: 10.1128/aac.34.5.899. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Greenberg R. N., Benes C. A. Time-kill studies with oxacillin, vancomycin, and teicoplanin versus Staphylococcus aureus. J Infect Dis. 1990 May;161(5):1036–1037. doi: 10.1093/infdis/161.5.1036. [DOI] [PubMed] [Google Scholar]
  11. Hackbarth C. J., Chambers H. F. Methicillin-resistant staphylococci: genetics and mechanisms of resistance. Antimicrob Agents Chemother. 1989 Jul;33(7):991–994. doi: 10.1128/aac.33.7.991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Johnson A. P., Uttley A. H., Woodford N., George R. C. Resistance to vancomycin and teicoplanin: an emerging clinical problem. Clin Microbiol Rev. 1990 Jul;3(3):280–291. doi: 10.1128/cmr.3.3.280. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Kaatz G. W., Seo S. M., Dorman N. J., Lerner S. A. Emergence of teicoplanin resistance during therapy of Staphylococcus aureus endocarditis. J Infect Dis. 1990 Jul;162(1):103–108. doi: 10.1093/infdis/162.1.103. [DOI] [PubMed] [Google Scholar]
  14. 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]
  15. Kureishi A., Jewesson P. J., Bartlett K. H., Cole C. D., Chow A. W. Application of a modified bioassay for monitoring serum teicoplanin and vancomycin in febrile neutropenic patients. Antimicrob Agents Chemother. 1990 Sep;34(9):1642–1647. doi: 10.1128/aac.34.9.1642. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Leclercq R., Derlot E., Duval J., Courvalin P. Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faecium. N Engl J Med. 1988 Jul 21;319(3):157–161. doi: 10.1056/NEJM198807213190307. [DOI] [PubMed] [Google Scholar]
  17. Leport C., Perronne C., Massip P., Canton P., Leclercq P., Bernard E., Lutun P., Garaud J. J., Vilde J. L. Evaluation of teicoplanin for treatment of endocarditis caused by gram-positive cocci in 20 patients. Antimicrob Agents Chemother. 1989 Jun;33(6):871–876. doi: 10.1128/aac.33.6.871. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Lewis P., Garaud J. J., Parenti F. A multicentre open clinical trial of teicoplanin in infections caused by gram-positive bacteria. J Antimicrob Chemother. 1988 Jan;21 (Suppl A):61–67. doi: 10.1093/jac/21.suppl_a.61. [DOI] [PubMed] [Google Scholar]
  19. Martino P., Venditti M., Micozzi A., Brandimarte C., Gentile G., Santini C., Serra P. Teicoplanin in the treatment of gram-positive-bacterial endocarditis. Antimicrob Agents Chemother. 1989 Aug;33(8):1329–1334. doi: 10.1128/aac.33.8.1329. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Maugein J., Pellegrin J. L., Brossard G., Fourche J., Leng B., Reiffers J. In vitro activities of vancomycin and teicoplanin against coagulase-negative staphylococci isolated from neutropenic patients. Antimicrob Agents Chemother. 1990 May;34(5):901–903. doi: 10.1128/aac.34.5.901. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Menichetti F., Del Favero A., Bucaneve G., Aversa F., Baldelli F., Felicini R., Terenzi A., Pauluzzi S. Teicoplanin in empirical combined antibiotic therapy of bacteraemias in bone marrow transplant patients. J Antimicrob Chemother. 1988 Jan;21 (Suppl A):105–111. doi: 10.1093/jac/21.suppl_a.105. [DOI] [PubMed] [Google Scholar]
  22. Nicas T. I., Wu C. Y., Hobbs J. N., Jr, Preston D. A., Allen N. E. Characterization of vancomycin resistance in Enterococcus faecium and Enterococcus faecalis. Antimicrob Agents Chemother. 1989 Jul;33(7):1121–1124. doi: 10.1128/aac.33.7.1121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Nováková I. R., Donnelly J. P., Verhagen C. S., De Pauw B. E. Teicoplanin as modification of initial empirical therapy in febrile granulocytopenic patients. J Antimicrob Chemother. 1990 Jun;25(6):985–993. doi: 10.1093/jac/25.6.985. [DOI] [PubMed] [Google Scholar]
  24. Rubin M., Hathorn J. W., Marshall D., Gress J., Steinberg S. M., Pizzo P. A. Gram-positive infections and the use of vancomycin in 550 episodes of fever and neutropenia. Ann Intern Med. 1988 Jan;108(1):30–35. doi: 10.7326/0003-4819-108-1-30. [DOI] [PubMed] [Google Scholar]
  25. Sahai J., Healy D. P., Shelton M. J., Miller J. S., Ruberg S. J., Polk R. Comparison of vancomycin- and teicoplanin-induced histamine release and "red man syndrome". Antimicrob Agents Chemother. 1990 May;34(5):765–769. doi: 10.1128/aac.34.5.765. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Shenep J. L., Hughes W. T., Roberson P. K., Blankenship K. R., Baker D. K., Jr, Meyer W. H., Gigliotti F., Sixbey J. W., Santana V. M., Feldman S. Vancomycin, ticarcillin, and amikacin compared with ticarcillin-clavulanate and amikacin in the empirical treatment of febrile, neutropenic children with cancer. N Engl J Med. 1988 Oct 20;319(16):1053–1058. doi: 10.1056/NEJM198810203191604. [DOI] [PubMed] [Google Scholar]
  27. Smith S. R., Cheesbrough J., Harding I., Davies J. M. Role of glycopeptide antibiotics in the treatment of febrile neutropenic patients. Br J Haematol. 1990 Dec;76 (Suppl 2):54–56. doi: 10.1111/j.1365-2141.1990.tb07938.x. [DOI] [PubMed] [Google Scholar]
  28. 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]
  29. Wade J. C. Antibiotic therapy for the febrile granulocytopenic cancer patient: combination therapy vs. monotherapy. Rev Infect Dis. 1989 Nov-Dec;11 (Suppl 7):S1572–S1581. doi: 10.1093/clinids/11.supplement_7.s1572. [DOI] [PubMed] [Google Scholar]
  30. Weems J. J., Jr, Lowrance J. H., Baddour L. M., Simpson W. A. Molecular epidemiology of nosocomial, multiply aminoglycoside resistant Enterococcus faecalis. J Antimicrob Chemother. 1989 Aug;24(2):121–130. doi: 10.1093/jac/24.2.121. [DOI] [PubMed] [Google Scholar]
  31. Yao J. D., Thauvin-Eliopoulos C., Eliopoulos G. M., Moellering R. C., Jr Efficacy of teicoplanin in two dosage regimens for experimental endocarditis caused by a beta-lactamase-producing strain of Enterococcus faecalis with high-level resistance to gentamicin. Antimicrob Agents Chemother. 1990 May;34(5):827–830. doi: 10.1128/aac.34.5.827. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Antimicrobial Agents and Chemotherapy are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES