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Teicoplanin in the treatment of gram-positive-bacterial endocarditis
P Martino1, M Venditti, A Micozzi
1Cattedra di Ematologia, Dipartimento di Biopatologia Umana, Rome, Italy.
Abstract:
Intravenous teicoplanin has been used to treat 23 cases of gram-positive-bacterial endocarditis, usually with 3 to 7 mg/kg every 12 h on the first day, followed by 3 to 7 mg/kg every 24 h. For some cases (staphylococcal and enterococcal endocarditis), the dosage was 8 to 14.4 mg/kg per day and/or other antibiotics were given. The mean duration was 48.2 days (range, 23 to 130 days). Of 23 patients, 21 (91.3%) had negative cultures or were cured. A total of 18 patients were treated with teicoplanin alone; of these, 4 had surgery, and all (except 2 who relapsed) were cured. Teicoplanin was combined with one or more antibiotics in five cases; in all cases appropriate cultures were negative, but three patients died during therapy or follow-up. Mild renal impairment was seen in two patients; both were receiving teicoplanin in combination with an aminoglycoside. We conclude that intravenous teicoplanin administered once a day at doses of 7 to 14 mg/kg per day is well tolerated, easy to administer, and may represent an efficacious therapy for gram-positive-bacterial endocarditis.
Insights
Intravenous teicoplanin effectively treated gram-positive bacterial endocarditis in 21 of 23 patients. Once-daily dosing proved well-tolerated and efficacious for this serious infection.
Area of Science:
- Infectious Diseases
- Pharmacology
- Cardiology
Background:
- Bacterial endocarditis is a serious infection of the heart lining.
- Gram-positive bacteria are common causative agents.
- Intravenous antibiotics are the standard treatment.
Purpose of the Study:
- To evaluate the efficacy and tolerability of intravenous teicoplanin for gram-positive bacterial endocarditis.
- To determine optimal dosing and duration of teicoplanin therapy.
Main Methods:
- Retrospective analysis of 23 patients with gram-positive bacterial endocarditis treated with intravenous teicoplanin.
- Dosing regimens varied, with a common initial dose followed by daily maintenance.
- Treatment duration ranged from 23 to 130 days.
Main Results:
- A high cure rate of 91.3% (21/23 patients) was achieved.
- Teicoplanin monotherapy was successful in most cases, including those with surgery.
- Mild renal impairment occurred in two patients on combination therapy.
Conclusions:
- Intravenous teicoplanin is a well-tolerated and effective treatment for gram-positive bacterial endocarditis.
- Once-daily administration at 7-14 mg/kg/day is recommended.
- Teicoplanin offers a viable therapeutic option for this challenging infection.