Lazzarini L, Tramarin A, Bragagnolo L, Tositti G, Manfrin V, de Lalla F
Department of Infectious and Tropical Diseases, Ospedale S. Bortolo, Vicenza, Italy.
J Chemother. 2002 Feb;14(1):71-5. doi: 10.1179/joc.2002.14.1.71.
Treatment of osteomyelitis requires prolonged hospital stay, lengthy antibiotic therapy and adequate surgical debridement. Outpatient parenteral antibiotic therapy (OPAT) is a new approach to reduce patient discomfort and hospital costs. Teicoplanin, a glycopeptide antibiotic with a long half-life (72 hours), is one of the most useful drugs for OPAT. We performed a pilot study to assess the safety and efficacy of three-times weekly teicoplanin in the treatment of methicillin-resistant (MR) acute staphylococcal osteomyelitis. Ten patients with acute post-traumatic osteomyelitis were enrolled. Pathogens were MR Staphylococcus aureus (5 patients) and MR coagulase-negative staphylococci (5 patients). After a loading dose of 400 mg b.i.d. for 3 days, patients were treated with an intravenous dose of 1000 mg on Mondays and Wednesdays and with a 1200 mg dose on Fridays. Teicoplanin trough levels were maintained within a 10 to 20 mg/L range. If hardware removal had been possible at enrollment, treatment was carried out for at least 4 weeks. If, on the contrary, hardware removal had not been possible, teicoplanin was administered as suppressive therapy until hardware removal. Treatment was successfully performed in 9 out of 10 patients, whereas in one patient only improvement was achieved. Side effects were not recorded. Three times weekly teicoplanin seems to be a valuable option in the treatment of acute MR staphylococcal osteomyelitis. Further studies are warranted in order to better define the role of this new administration schedule in this field.
骨髓炎的治疗需要长时间住院、长期抗生素治疗以及充分的外科清创术。门诊胃肠外抗生素治疗（OPAT）是一种减少患者不适和医院成本的新方法。替考拉宁是一种半衰期长（72小时）的糖肽类抗生素，是OPAT最有用的药物之一。我们进行了一项前瞻性研究，以评估每周三次替考拉宁治疗耐甲氧西林（MR）急性葡萄球菌骨髓炎的安全性和有效性。纳入了10例急性创伤后骨髓炎患者。病原体为MR金黄色葡萄球菌（5例）和MR凝固酶阴性葡萄球菌（5例）。在给予400mg bid的负荷剂量3天后，患者在周一和周三接受1000mg静脉注射，周五接受1200mg静脉注射。替考拉宁谷浓度维持在10至20mg/L范围内。如果在入组时可以取出内固定物，则治疗至少进行4周。相反，如果无法取出内固定物，则给予替考拉宁作为抑制性治疗，直到取出内固定物。10例患者中有9例治疗成功，而1例仅有所改善。未记录到副作用。每周三次替考拉宁似乎是治疗急性MR葡萄球菌骨髓炎的一种有价值的选择。有必要进行进一步研究，以更好地确定这种新给药方案在该领域的作用。
