Hahn-Ast C, Glasmacher A, Arns A, Mühling A, Orlopp K, Marklein G, Von Lilienfeld-Toal M
Department of Internal Medicine I, University of Bonn, Bonn, Germany,
Infection. 2008 Feb;36(1):54-8. doi: 10.1007/s15010-007-7126-4. Epub 2008 Jan 12.
Glycopeptides are often used for persistent fever in neutropenic patients. This study compares efficacy and toxicity of teicoplanin and vancomycin.
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.
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.
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.
糖肽类药物常用于中性粒细胞减少患者的持续发热。本研究比较替考拉宁和万古霉素的疗效及毒性。
连续100例血液系统恶性肿瘤且在一线抗生素治疗（91%为哌拉西林/他唑巴坦）72小时后仍持续发热的中性粒细胞减少患者，于1996年8月至2000年9月接受替考拉宁（第1天800mg，之后每日400mg）+哌拉西林/他唑巴坦+庆大霉素治疗（T组），或于2000年10月至2002年4月接受万古霉素（每日2g）+美罗培南+左氧氟沙星治疗（V组）。成功标准为退热（≥7天）且无任何持续感染迹象。每日监测肾毒性，以血清肌酐升高情况为准。
每组分析50例患者。仅对以哌拉西林/他唑巴坦作为一线治疗的患者评估疗效。T组76%（n = 42）治疗成功，V组59%（n = 49）治疗成功，p = 0.118。对所有患者评估毒性。T组肌酐升高中位数为11%（四分位间距0% - 30%），V组为17%（0% - 74%），p = 0.062。在接受两性霉素B联合治疗的患者中（分别给药7天和6天，p = 0.525），T组肌酐中位数从0.9mg/dl（0.8 - 1.1）升至1.2mg/dl（0.9 - 1.5），V组从0.9mg/dl（0.8 - 1.08）升至1.55mg/dl（1.33 - 2.23）（p < 0.001）。这导致T组2/23（9%）患者和V组9/16（56%）患者的肌酐翻倍（p = 0.003）。多因素分析显示，联合使用两性霉素B（p < 0.001）和万古霉素治疗（p = 0.002）与肾毒性独立相关。
替考拉宁和万古霉素对中性粒细胞减少和持续发热患者疗效相当，但与两性霉素B联用时，万古霉素的肾毒性显著高于替考拉宁。
