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Right-sided endocarditis caused by Staphylococcus aureus in drug abusers
J Fortún1, J A Pérez-Molina, M T Añón
1Infectious Disease Unit, Hospital Ramón y Cajal, Madrid, Spain.
Antimicrobial Agents and Chemotherapy
|February 1, 1995
Summary
Teicoplanin is not recommended for treating Staphylococcus aureus endocarditis in drug users. Lower dosages in the second week led to treatment failures and breakthrough bacteremia.
Area of Science:
- Infectious Diseases
- Cardiology
- Pharmacology
Background:
- Right-sided endocarditis in intravenous drug users is often caused by Staphylococcus aureus.
- Parenteral antibiotic therapy is the standard treatment, but optimal regimens require further investigation.
Purpose of the Study:
- To compare the efficacy of cloxacillin plus gentamicin versus teicoplanin for treating Staphylococcus aureus right-sided endocarditis in drug abusers.
- To evaluate the safety and effectiveness of a specific teicoplanin dosing regimen.
Main Methods:
- A prospective, open-label, randomized study.
- Group A: Cloxacillin (2g q4h) + Gentamicin (1.5mg/kg q8h) for 2 weeks.
- Group B: Teicoplanin (10mg/kg q12h days 1-3, 6mg/kg q12h days 4-7, 7mg/kg q24h day 8).
Main Results:
- Clinical failure occurred in 1/6 patients in Group A and 4/6 patients in Group B.
- Three patients in Group B experienced breakthrough bacteremia with teicoplanin-susceptible strains.
- Decreased serum teicoplanin levels and bactericidal titers were observed in the second week with 7mg/kg/day dosage.
Conclusions:
- The tested teicoplanin regimen, particularly the 7mg/kg/day dosage, is not recommended for Staphylococcus aureus endocarditis in drug abusers.
- Cloxacillin plus gentamicin demonstrated better clinical outcomes in this patient population.