Greenberg R N
Division of Infectious Diseases, University of Kentucky, Lexington 40536.
Antimicrob Agents Chemother. 1990 Dec;34(12):2392-7. doi: 10.1128/AAC.34.12.2392.
Teicoplanin, a glycopeptide antibiotic, was evaluated for safety and efficacy in the treatment of vascular-access-associated bacteremias and of bone and joint infections due to susceptible gram-positive organisms. Of 35 patients enrolled, 26 had osteomyelitis, 8 had vascular-access-associated bacteremias, and 1 had a joint infection. A total of 38 gram-positive isolates were identified: 23 Staphylococcus aureus and 6 coagulase-negative staphylococcus and 9 streptococcus isolates. After at least 6 months of follow-up, 17 patients were evaluable for efficacy: 10 of 14 (71%) with osteomyelitis and 3 of 3 with vascular-access-associated bacteremias had full resolution of their infections. Inadequate debridement, the presence of metal, and inadequate dosing were likely causes of two failures and two relapses in patients with osteomyelitis. For all but two organisms, teicoplanin MICs were less than or equal to 2 micrograms/ml. Patients who responded had median peak and trough serum bactericidal levels at serum dilutions of 1:64 and 1:16; trough levels of teicoplanin in serum were greater than 30 micrograms/ml. Patients did not respond as expected to daily doses of 4 mg/kg of body weight, which consequently were increased to greater than or equal to 15 mg/kg. Audiology testing of 20 patients found 2 with a mild loss of high-frequency hearing; 1 patient complained of tinnitus. Patients tolerated peak levels in serum as high as 127 micrograms/ml and trough levels of 49 micrograms/ml. However, 5 of 18 patients (28%) whose daily dose was greater than or equal to 12 mg/kg developed drug fever and rash and had teicoplanin discontinued. Further study of the antibiotic at such higher doses is needed.
替考拉宁是一种糖肽类抗生素，对其治疗因敏感革兰氏阳性菌引起的血管通路相关菌血症以及骨和关节感染的安全性和有效性进行了评估。在纳入的35例患者中，26例患有骨髓炎，8例患有血管通路相关菌血症，1例患有关节感染。共鉴定出38株革兰氏阳性菌：23株金黄色葡萄球菌、6株凝固酶阴性葡萄球菌和9株链球菌。经过至少6个月的随访，17例患者可评估疗效：14例骨髓炎患者中有10例（71%）、3例血管通路相关菌血症患者中有3例感染完全消退。清创不充分、金属植入物的存在以及给药剂量不足可能是骨髓炎患者出现两例治疗失败和两例复发的原因。除两种菌株外，替考拉宁的最低抑菌浓度均小于或等于2微克/毫升。有反应的患者在血清稀释度为1:64和1:16时的血清杀菌水平峰值和谷值中位数分别为：替考拉宁血清谷值水平大于30微克/毫升。患者对每日4毫克/千克体重的剂量未出现预期反应，因此剂量增加至大于或等于15毫克/千克。对20例患者进行的听力测试发现，2例有轻度高频听力损失；1例患者主诉耳鸣。患者能够耐受血清峰值水平高达127微克/毫升和谷值水平49微克/毫升。然而，18例每日剂量大于或等于12毫克/千克的患者中有5例（28%）出现药物热和皮疹，因此停用了替考拉宁。需要对如此高剂量的抗生素进行进一步研究。
