A review of the use of teicoplanin in haematological malignancy

Factors determining the change in patterns of antibiotic use in patients with haematological malignancies include the growing numbers of infections caused by Gram-positive pathogens, the increasing reliance on indwelling catheters, and strategic movement away from inpatient therapy towards day-case and non-inpatient therapy. The suitability of teicoplanin in this context is examined. The indications for teicoplanin use are now established as: early use in clinically infected patients; as a second-line agent for sensitive pathogens; and in primary antibiotic failures. Teicoplanin should not be used as empirical therapy in fevers of unknown origin; neither should teicoplanin be used as prophylaxis (the situations of infection in chemotherapy patients or for Hickman catheter insertion in particular are discussed). Comparative studies versus vancomycin have shown teicoplanin to be equally effective and to be well tolerated. Teicoplanin's good safety profile and ease of use make it particularly useful for non-inpatient therapy. Problems are posed for both glycopeptides by specific resistant pathogens, although these pathogens are currently not common. Haematologists must be aware of, and guard against, abuse of the glycopeptides in their own and other fields, including oral gut decontamination, the treatment of Clostridium difficile and veterinary use.