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Intravenous teicoplanin does not prevent Clostridium difficile associated diarrhea
C Wenisch1, E Etzersdorfer, S Breyer
1Abteilung für Infektionen, Universitätsklinik Wien, Austria.
Abstract:
A 59-year-old man with the diagnosis of endocarditis of the mitral valve due to Streptococcus mitis was treated with penicillin G, gentamicin, and later with clindamycin as inpatient for 3 weeks. Thereafter outpatient therapy with parenteral teicoplanin 3 x per week was initiated. After 17 days of teicoplanin treatment he developed severe diarrhea, and stool samples were positive for Clostridium difficile toxin. In addition to the ongoing parenteral therapy with teicoplanin, oral teicoplanin was administered. On the third day of this regimen the diarrhea and other disabling symptoms subsided, and test results for C. difficile toxin became negative. Oral teicoplanin was continued for 10 days and cleared C. difficile effectively after treatment as assessed by consecutive stool cultures (until 60 days thereafter). The parenteral administration of teicoplanin could not prevent the onset of C. difficile associated diarrhea in this patient, who previously had been treated with clindamycin. Thus, the administration of parenteral teicoplanin does not seem to be a treatment option for C. difficile associated diarrhea in patients in which oral therapy is not possible.
Insights
Parenteral teicoplanin did not prevent Clostridium difficile-associated diarrhea in an endocarditis patient. Oral teicoplanin effectively treated the diarrhea, suggesting it is a viable option when oral administration is possible.
Area of Science:
- Infectious Diseases
- Pharmacology
- Microbiology
Background:
- Endocarditis caused by Streptococcus mitis requires effective antibiotic treatment.
- Clindamycin and parenteral teicoplanin were administered to a patient with mitral valve endocarditis.
- Clostridium difficile-associated diarrhea (CDAD) is a potential complication of antibiotic therapy.
Observation:
- A patient developed severe diarrhea and tested positive for Clostridium difficile toxin during parenteral teicoplanin treatment for endocarditis.
- The patient had a history of clindamycin treatment prior to teicoplanin therapy.
Findings:
- Concurrent oral teicoplanin administration led to symptom resolution and negative C. difficile toxin tests.
- Oral teicoplanin effectively cleared C. difficile infection for up to 60 days post-treatment.
- Parenteral teicoplanin did not prevent CDAD in this patient, despite prior clindamycin treatment.
Implications:
- Oral teicoplanin appears to be an effective treatment for CDAD when oral administration is feasible.
- Parenteral teicoplanin is not recommended for treating CDAD, especially in patients with prior clindamycin exposure.
- This case highlights the importance of considering CDAD in patients receiving antibiotics and the potential role of oral teicoplanin in its management.