Teicoplanin versus vancomycin in the empirical treatment of febrile neutropenic patients

• Published in: European journal of haematology. Supplementum Vol. 54; p. 18
• Main Authors: Chow, A W, Jewesson, P J, Kureishi, A, Phillips, G L
• Format: Journal Article
• Language: English
• Published: England 01.12.1993
• Subjects: Adult; Aged; Antineoplastic Agents - adverse effects; Antineoplastic Agents - therapeutic use; Bone Marrow Transplantation; Catheterization, Central Venous; Catheters, Indwelling; Combined Modality Therapy; Double-Blind Method; Drug Therapy, Combination - therapeutic use; Female; Fever - microbiology; Gram-Positive Bacterial Infections - drug therapy; Gram-Positive Bacterial Infections - etiology; Humans; Immunocompromised Host; Incidence; Kidney Diseases - chemically induced; Leukemia - complications; Leukemia - therapy; Male; Middle Aged; Multicenter Studies as Topic; Neutropenia - chemically induced; Neutropenia - complications; Penicillins - therapeutic use; Prevalence; Prospective Studies; Sepsis - drug therapy; Sepsis - etiology; Sepsis - microbiology; Superinfection - epidemiology; Superinfection - etiology; Teicoplanin - adverse effects; Teicoplanin - pharmacokinetics; Teicoplanin - therapeutic use; Tobramycin - therapeutic use; Treatment Outcome; Vancomycin - adverse effects; Vancomycin - pharmacokinetics; Vancomycin - therapeutic use
• ISSN: 0902-4506
• DOI: 10.1111/j.1600-0609.1993.tb01901.x

Gram-positive infections have become prevalent among neutropenic patients with cancer. A prospective, randomized, double-blind trial of teicoplanin, 6 mg/kg every 12 h for three doses then every 24 h, versus vancomycin hydrochloride, 15 mg/kg every 12 h, in the empirical treatment of febrile neutropenic patients was undertaken among 50 consecutive patients with haematological malignancy. The patients also received piperacillin sodium, 3 g every 4 h, and tobramycin sulphate, 1.5-2 mg/kg every 8 h. Both groups (25 teicoplanin and 25 vancomycin) were comparable in age, sex, renal function, underlying disease and concurrent therapy. Among 22 patients (44%) with culture-proven infection, Gram-positive organisms were isolated in 15 (9 with bacteraemia) and Gram-negative in 11 (4 with bacteraemia). Mixed or polymicrobial infection occurred in 8 patients. Serum 1-h peak and trough levels at steady state were 41 +/- 15 and 12 +/- 3 mg/l for teicoplanin (at 14 +/- 4 days), and 40 +/- 10 and 8 +/- 5 mg/l for vancomycin (at 0.9 +/- 0.6 days). Mean elimination half-life and apparent volume of distribution at steady state were 80.5 +/- 21.5 h and 1.4 +/- 0.8 l/kg for teicoplanin, and 5.6 +/- 1.8 h and 0.6 +/- 0.2 l/kg for vancomycin. Empirical antimicrobial therapy was successful in 23 teicoplanin and 21 vancomycin patients, respectively (p = 0.67; two-tailed Fisher's exact test). Nephrotoxicity (serum creatinine > 110 mmol/l), however, was more common among vancomycin patients (10 versus 2; p = 0.02), while termination of treatment due to adverse effects was also more common among vancomycin patients (10 versus 2; p = 0.02).