Therapy of serious gram-positive infections with teicoplanin

Teicoplanin was used as monotherapy in 17 seriously ill patients (mean age 51 years, range 18-71) with infection due to Gram-positive organisms. The dose used was 200 mg teicoplanin intravenously once daily after an initial intravenous dose of 400 mg. Most of the patients (15 out of 17) were septicaemic (confirmed by blood culture), the other two had deep abscesses. The pathogens isolated were Staphylococcus epidermidis [15], Streptococcus faecium [1] and JK Coryneform [1]. The 15 patients with Staph. epidermidis infections had all been treated previously with a beta-lactam (usually flucloxacillin)/aminoglycoside combination to which Staph. epidermidis was resistant. All patients were still pyrexial after 48 h of therapy and were then changed to teicoplanin as monotherapy. Patients were treated with teicoplanin for 5 to 7 days. One was withdrawn because of vomiting associated with the teicoplanin infusion, and another was withdrawn because she was given amikacin for a separate Gram-negative infection, but all the other 15 patients responded well to therapy, usually becoming apyrexial within 48 h. All 15 septicaemic patients had central lines in situ: 10 responded to therapy with the line left in situ but in 5 the lines were removed, either before or during teicoplanin therapy. Teicoplanin levels were determined in all patients, usually on day 2, with no evidence of toxicity from these levels. Teicoplanin was found to be effective as monotherapy for septicaemia mainly due to Staph. epidermidis in patients with severe underlying disease.