Nineteen patients hospitalized for serious gram-positive
infections were treated with
teicoplanin, a new
glycopeptide antibiotic. A variety of
infections were treated, including
endocarditis, septic
thrombophlebitis,
osteomyelitis, pyogenic
arthritis, and
soft tissue infection. Of 13
infections that could be evaluated in 12 patients, there were 8 clinical cures, 2 improvements, 1 recurrence, and 2 failures. Of the eight patients with Staphylococcus aureus
bacteremia, seven were clinically cured or improved with
teicoplanin therapy. Of the nine patients in whom the bacteriological response to treatment could be fully evaluated, six were cured; there was recurrence of
infection in one, and treatment failed in two patients. In vitro testing showed the 13 bacterial isolates (9 S. aureus, 3 S. epidermidis, and 1 group B streptococcus) to be uniformly susceptible to
teicoplanin, with MICs ranging from 0.12 to 0.5 microgram/ml. Every isolate was more susceptible in vitro to
teicoplanin than to
vancomycin. Three of the staphylococcal isolates were resistant to
methicillin. Pharmacokinetic studies demonstrated that after an initial
drug-accumulation period, a single daily dose adequately maintained the
teicoplanin concentrations in serum within therapeutic ranges.
Teicoplanin also penetrated well into synovial fluid. The
drug was well tolerated by either intravenous or intramuscular administration. The most significant adverse reaction was an urticarial
rash which required discontinuation of
therapy in one patient; a second patient experienced a modest decrease in high-frequency auditory threshold. Asymptomatic
eosinophilia and mild elevation of serum
transaminases were noted as well. The results of this study suggest that
teicoplanin is a safe and effective new agent for treatment of serious
infections caused by gram-positive organisms.