An audit of efficacy and toxicity of teicoplanin versus vancomycin in febrile neutropenia: is the different toxicity profile clinically relevant?

BACKGROUND

Glycopeptides are often used for persistent fever in neutropenic patients. This study compares efficacy and toxicity of teicoplanin and vancomycin.

PATIENTS AND METHODS

Hundred consecutive neutropenic patients with hematological malignancies and persistent fever after 72 h of first-line antibiotic therapy (91% piperacillin/tazobactam) were treated with teicoplanin (800 mg on day 1, then 400 mg/day)+piperacillin/tazobactam+gentamicin from 08/96 to 09/00 (group T) or with vancomycin (2 g/day)+meropenem+levofloxacin from 10/00 to 04/02 (group V). Success was defervescence (>or=7 days) in absence of any sign of continuing infection. Nephrotoxicity was monitored daily as increase in serum creatinine.

RESULTS

Fifty patients were analyzed in each group. Efficacy was evaluated in patients with piperacillin/tazobactam as first-line therapy only. Treatment was successful in 76% in group T (n=42) and 59% in group V (n=49), p=0.118. Toxicity was evaluated in all patients. The median increase of creatinine was 11% (interquartile range 0%-30%) in group T and 17% (0%-74%) in group V, p=0.062. In patients who received concomitant amphotericin B (given for 7 days and 6 days, respectively, p=0.525), median creatinine increased from 0.9 mg/dl (0.8-1.1) to 1.2 mg/dl (0.9-1.5) in group T and from 0.9 mg/dl (0.8-1.08) to 1.55 mg/dl (1.33-2.23) in group V (p<0.001). This led to a doubling of creatinine in 2/23 (9%) patients of group T and in 9/16 (56%) patients of group V (p=0.003). A multivariate analysis revealed that concomitant use of amphotericin B (p<0.001) and treatment with vancomycin (p=0.002) were independently associated with nephrotoxicity.

CONCLUSION

Teicoplanin and vancomycin were comparably effective in patients with neutropenia and persistent fever, but - if combined with amphotericin B - vancomycin was significantly more nephrotoxic than teicoplanin.