Teicoplanin or vancomycin in the treatment of gram-positive infections?

Abstract

The glycopeptide antibiotics vancomycin and teicoplanin have similar mechanisms of action on bacterial cell wall synthesis. Their spectra of activity are limited to Gram-positive bacteria, with the degree of bactericidal activity depending on the species of micro-organism. Staphylococcus aureus, Staphylococcus epidermis, enterococci and Clostridium difficile are generally sensitive, including methicillin-resistant strains of S. aureus and S. epidermidis. Glycopeptide resistance has recently emerged in staphylococci and enterococci. Vancomycin has a shorter half-life than teicoplanin and requires multiple dosing to maintain adequate serum levels. It can only be given by prolonged intravenous infusion over 1 h. In contrast, the pharmacokinetics of teicoplanin allow for once-daily dosing, either by rapid intravenous infusion or by the intramuscular route. The latter offers reliable absorption for patients with limited venous access and is also of benefit for out-patient therapy. Teicoplanin is a safer drug than vancomycin. It is associated with a lower incidence of nephrotoxicity or ototoxicity. Compared to vancomycin, the availability of the intramuscular route and the absence of a requirement for routine serum monitoring, together with the reduced need to treat drug-related side-effects make teicoplanin more cost-effective. It is as effective as vancomycin for most indications, is safe, easy to administer and an important agent for treating Gram-positive infections. Its role in hospitals is likely to increase if the price of drug acquisition is kept low.

• Authors: S Murphy, R J Pinney
• Journal: Journal of clinical pharmacy and therapeutics (J Clin Pharm Ther) Vol. 20 Issue 1 Pg. 5-11 (Feb 1995) ISSN: 0269-4727 [Print] England
• PMID: 7775615 (Publication Type: Journal Article, Review)

Chemical References

• Teicoplanin
• Vancomycin

Topics

• Cell Wall (drug effects)
• Cost-Benefit Analysis
• Drug Resistance, Microbial
• Gram-Positive Bacteria (drug effects)
• Gram-Positive Bacterial Infections (drug therapy)
• Half-Life
• Humans
• Teicoplanin (adverse effects, pharmacokinetics, pharmacology, therapeutic use)
• Vancomycin (adverse effects, pharmacokinetics, pharmacology, therapeutic use)