Teicoplanin--home therapy for prosthetic joint infections

Infection with methicillin-resistant organisms is increasingly common among implanted orthopaedic devices. The organisms involved are often multiresistant to other commonly used antibiotics. Rifampicin resistance is less common at isolation but may develop during treatment unless combination therapy with another drug is employed. However, tolerance of combinations is poor, particularly among elderly patients. These patients may require at least 6 weeks of antibiotic therapy, and where there is no suitable oral therapy, this has meant prolonged hospitalization solely for administration of parenteral antibiotics. Recently we have started treating such patients with teicoplanin, 6 mg/kg once daily, by intravenous bolus injection. The injections are administered by relatives at home and the patients attend the ward twice weekly for inspection and changing of the intravenous cannula. The potential for home administration of parenteral teicoplanin gives this drug a major advantage over other parenteral drugs for the treatment of prosthetic joint infections.