Teicoplanin as modification of initial empirical therapy in febrile granulocytopenic patients

Teicoplanin at a dose of 400 mg per day was added to the initial empirical therapy of 65 of 202 febrile granulocytopenic episodes. Of 53 cases evaluable for outcome 23 (43%) responded. Responders and nonresponders were comparable in terms of time of starting teicoplanin treatment, duration of therapy and of granulocytopenia, number of granulocytopenic days after therapy was stopped and peak and through concentrations of the drug. Teicoplanin was given most often because of persistent fever or initial Gram-positive bacteraemia and only one-third of these cases responded. However, when teicoplanin was given because of proven or presumed Gram-positive infection 67% of cases were treated successfully. Patients with skin and soft tissue infections achieved a 78% response rate. The development of a lung infiltrate was the most common reason for failure to respond, although in most instances the aetiology was not determined. Serum concentrations of teicoplanin were predictable; peak and trough concentrations on the fourth day were 30.4 +/- 5.0 mg/l and 9.8 +/- 1.7 mg/l, respectively. Concentrations achieved in individual patients did not correspond to outcome. Hearing loss of 20 dB at 800 Hz was noted in one of 15 cases and transient liver or kidney disturbances attributable to the drug were observed in 4% of cases. Teicoplanin therapy was safe but only effective when used to treat infective episodes with a high probability of being due to Gram-positive bacteria.