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Updated: Oct 8, 2026
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Anti-infective treatment in intensive care: the role of glycopeptides
1Department of Clinical Microbiology, University College Hospital, London, UK.
Abstract:
Antibiotics are used in 80% of patients in the ICU, encouraging nosocomial infections with resistant organisms. If the antibiotic susceptibilities of the pathogen are known, a narrow-spectrum antibiotic is preferable to preserve the patient's resistance to colonization. However, treatment is often empirical and broad-spectrum combinations are commonly used. Gram-positive bacteraemia is associated with invasive monitoring or intravascular catheters. If the device cannot be removed easily, the glycopeptides are the only agents likely to be active against most strains of the commonest pathogen, the coagulase-negative staphylococcus. Long-stay patients are susceptible to infection with enterococci and methicillin-resistant Staphylococcus aureus, which are often resistant to all the usual agents other than glycopeptides. Vancomycin is long established, but is nephrotoxic, requires serum monitoring, must be administered as an infusion and can cause red man syndrome. Teicoplanin can be given as a single daily bolus without similar side-effects or monitoring. In deep-seated staphylococcal infection, the usual dose of teicoplanin is adequate if given in combination with other agents, but it may need to be doubled if used as monotherapy. Monitoring of the levels in the serum is helpful to ensure an adequate dose in patients with renal failure or in drug abusers, but is not needed to prevent toxicity.
Insights
Antibiotic resistance is a growing concern in ICUs. Teicoplanin offers a safer alternative to vancomycin for treating resistant Gram-positive infections, with fewer side effects and simpler administration.
Area of Science:
- Infectious Diseases
- Clinical Pharmacology
- Intensive Care Medicine
Background:
- Antibiotics are extensively used in ICUs, contributing to nosocomial infections by resistant organisms.
- Empirical broad-spectrum antibiotic use is common, despite the preference for narrow-spectrum agents when pathogen susceptibilities are known.
- Gram-positive bacteremia, often linked to invasive devices, necessitates effective treatment options.
Purpose of the Study:
- To evaluate teicoplanin as a treatment option for Gram-positive infections in ICU patients.
- To compare the efficacy and safety profile of teicoplanin with vancomycin.
- To assess the optimal dosing and monitoring requirements for teicoplanin.
Main Methods:
- Review of clinical data on antibiotic use in ICUs.
- Analysis of pathogens commonly causing Gram-positive bacteremia in long-stay patients.
- Comparison of side effect profiles and administration requirements for vancomycin and teicoplanin.
Main Results:
- Glycopeptides like vancomycin and teicoplanin are crucial for treating infections caused by resistant organisms such as coagulase-negative staphylococci, enterococci, and methicillin-resistant Staphylococcus aureus.
- Vancomycin presents risks including nephrotoxicity, requires serum monitoring and infusion administration, and can cause red man syndrome.
- Teicoplanin can be administered as a single daily bolus, potentially avoiding vancomycin's side effects and monitoring needs. Higher doses may be required for monotherapy in deep-seated infections.
Conclusions:
- Teicoplanin presents a favorable alternative to vancomycin for managing resistant Gram-positive infections in the ICU setting.
- Its simpler administration and potentially reduced toxicity profile warrant consideration in clinical practice.
- Further research may refine dosing strategies, particularly for monotherapy in severe infections.
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