Teicoplanin, a
glycopeptide antibiotic, was evaluated for safety and efficacy in the treatment of vascular-access-associated
bacteremias and of bone and joint
infections due to susceptible gram-positive organisms. Of 35 patients enrolled, 26 had
osteomyelitis, 8 had vascular-access-associated
bacteremias, and 1 had a joint
infection. A total of 38 gram-positive isolates were identified: 23 Staphylococcus aureus and 6
coagulase-negative staphylococcus and 9 streptococcus isolates. After at least 6 months of follow-up, 17 patients were evaluable for efficacy: 10 of 14 (71%) with
osteomyelitis and 3 of 3 with vascular-access-associated
bacteremias had full resolution of their
infections. Inadequate
debridement, the presence of
metal, and inadequate dosing were likely causes of two failures and two relapses in patients with
osteomyelitis. For all but two organisms,
teicoplanin MICs were less than or equal to 2 micrograms/ml. Patients who responded had median peak and trough serum bactericidal levels at serum dilutions of 1:64 and 1:16; trough levels of
teicoplanin in serum were greater than 30 micrograms/ml. Patients did not respond as expected to daily doses of 4 mg/kg of
body weight, which consequently were increased to greater than or equal to 15 mg/kg. Audiology testing of 20 patients found 2 with a mild loss of high-frequency hearing; 1 patient complained of
tinnitus. Patients tolerated peak levels in serum as high as 127 micrograms/ml and trough levels of 49 micrograms/ml. However, 5 of 18 patients (28%) whose daily dose was greater than or equal to 12 mg/kg developed
drug fever and
rash and had
teicoplanin discontinued. Further study of the
antibiotic at such higher doses is needed.