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Experience with outpatient intravenous teicoplanin therapy for chronic osteomyelitis
W Graninger1, C Wenisch, E Wiesinger
1Department of Internal Medicine I, University Hospital of Vienna, Austria.
Abstract:
Thirty-seven patients with acute exacerbations of chronic osteomyelitis caused by methicillin-susceptible Staphylococcus aureus (n = 13), methicillin-resistant Staphylococcus aureus (n = 12), methicillin-susceptible coagulase-negative staphylococci (n = 9), methicillin-resistant coagulase-negative staphylococci (n = 1) and enterococci (n = 2) were treated intravenously with teicoplanin. After a loading dose of 7 to 16 mg/kg (median 11 mg/kg) for 4 to 7 days, patients received 9 to 25 mg/kg (median 14 mg/kg) on Mondays, Wednesdays and Fridays in an outpatient setting to reach trough serum levels between 5 mg/l and 15 mg/l. The duration of treatment ranged from 28 to 150 days (median 60 days). Cure was obtained in 14 (38%) and improvement in 17 (46%) cases, and failure was observed in 6 (16%) patients. Adverse effects occurred in 6 patients, and caused discontinuation of treatment in 3 patients. The financial savings exceeded US$60,000 per patient compared with the high hospitalization costs of inpatient treatment.
Insights
Teicoplanin effectively treated chronic osteomyelitis exacerbations in 37 patients, achieving cure or improvement in 84% of cases. This outpatient treatment also resulted in significant financial savings compared to hospitalization.
Area of Science:
- Infectious Diseases
- Orthopedic Surgery
- Pharmacology
Background:
- Chronic osteomyelitis presents a significant treatment challenge, often requiring prolonged antibiotic therapy.
- Acute exacerbations necessitate effective management to prevent complications and improve patient outcomes.
- Intravenous antibiotic administration is typically associated with lengthy hospitalizations.
Purpose of the Study:
- To evaluate the efficacy and safety of outpatient intravenous teicoplanin for acute exacerbations of chronic osteomyelitis.
- To assess the clinical outcomes and adverse effects associated with this treatment regimen.
- To determine the potential financial benefits of outpatient teicoplanin therapy.
Main Methods:
- A cohort of 37 patients with acute exacerbations of chronic osteomyelitis received intravenous teicoplanin.
- Treatment involved an initial loading dose followed by a thrice-weekly outpatient regimen targeting specific serum trough levels.
- Treatment duration varied, with outcomes and adverse events meticulously recorded.
Main Results:
- A high success rate was observed, with 14 patients (38%) cured and 17 (46%) improved, totaling 84%.
- Adverse effects were reported in 6 patients, leading to treatment discontinuation in 3.
- Significant cost savings, exceeding $60,000 per patient, were realized compared to inpatient care.
Conclusions:
- Outpatient intravenous teicoplanin is an effective and safe treatment option for acute exacerbations of chronic osteomyelitis.
- This approach offers substantial financial advantages by reducing the need for hospitalization.
- Teicoplanin demonstrates a favorable clinical outcome profile in managing complex bone infections.