Tolerability of teicoplanin in 117 hospitalized adults with previous vancomycin-induced fever, rash, or neutropenia: a retrospective chart review.
Abstract | BACKGROUND:
Vancomycin has reliable antibacterial activity against many gram-positive pathogens but is associated with many adverse events. Teicoplanin, another glycopeptide, is associated with fewer adverse events, but its use in patients with previous vancomycin-induced adverse reactions remains controversial. OBJECTIVES: METHODS: RESULTS:
Antibiotic therapy was switched to teicoplanin in 117 patients with vancomycin-induced fever alone (n = 24), rash alone (n = 77), both drug fever and rash (n = 8), or neutropenia (n = 8). The mean (SD) age of these patients was 53.1 (22.8) years, and 65 (56%) were male. The major clinical indications for vancomycin therapy among these patients were wound infections (21%), respiratory tract infections (14%), and bacteremia (13%). The dosages for vancomycin ranged from 1 g every 5 days to 1 g BID, and for teicoplanin ranged from 400 mg daily to 400 mg q72h, adjusted by the degree of renal dysfunction. Overall, 12 patients with vancomycin-induced fever (n = 2), rash (n = 6), or neutropenia (n = 4) subsequently developed teicoplanin-induced fever (n = 3), rash (n = 3), or neutropenia (n = 6). Specifically, of 8 patients with vancomycin-induced neutropenia, 4 (50%) subsequently developed neutropenia after switching to teicoplanin. Vancomycin- and teicoplanin-induced neutropenia was often noted after 1 week of treatment. Among patients with vancomycin-induced fever, rash, or neutropenia, there were no differences between patients with or without teicoplanin-induced fever, rash, or neutropenia in terms of age, sex, weight, dosage or duration of vancomycin therapy, dosage of teicoplanin, or underlying disease. There was no difference in mortality rates between patients with or without teicoplanin-induced fever, rash, or neutropenia. The cause of all deaths was progression of infectious or underlying disease, unrelated to vancomycin or teicoplanin use. CONCLUSIONS:
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Authors | Yuan-Pin Hung, Nan-Yao Lee, Chia-Ming Chang, Hsin-Chun Lee, Chi-Jung Wu, Po-Lin Chen, Ching-Chi Lee, Chih-Huan Chung, Wen-Chien Ko |
Journal | Clinical therapeutics
(Clin Ther)
Vol. 31
Issue 9
Pg. 1977-86
(Sep 2009)
ISSN: 1879-114X [Electronic] United States |
PMID | 19843487
(Publication Type: Journal Article)
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Chemical References |
- Anti-Bacterial Agents
- Teicoplanin
- Vancomycin
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Topics |
- Adult
- Aged
- Anti-Bacterial Agents
(administration & dosage, adverse effects, therapeutic use)
- Dose-Response Relationship, Drug
- Drug Eruptions
(etiology)
- Female
- Fever
(chemically induced)
- Gram-Positive Bacterial Infections
(drug therapy)
- Hospitals, University
- Humans
- Male
- Middle Aged
- Neutropenia
(chemically induced)
- Retrospective Studies
- Taiwan
- Teicoplanin
(administration & dosage, adverse effects, therapeutic use)
- Vancomycin
(administration & dosage, adverse effects, therapeutic use)
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