Teicoplanin in combination therapy for febrile episodes in neutropenic and non-neutropenic paediatric patients.

The aim of this study was to assess the efficacy and safety of teicoplanin in combination with other antimicrobial agents for therapy of severe suspected or proven Gram-positive infection in children and also to determine a dosage regimen for paediatric patients. Twenty children were given 23 courses of teicoplanin therapy for 11 septicaemias, one erysipelas, one cellulitis and 11 cases of fever of unknown origin. Eighteen of the 20 patients had severe underlying disease: one solid tumour, 15 acute lymphoblastic leukaemias, two acute myeloblastic leukaemias; 15 were neutropenic; 19 had a central line. Thirteen Gram-positive bacteria were isolated from the blood cultures in eleven patients. There were eight coagulase-negative staphylococci (CNS), (five methicillin-resistant) and four Staphylococcus aureus isolates. Teicoplanin was given as a 30 min infusion twice on the first day then once a day. The mean unit dose was 6 mg/kg for first eight patients. One clinical failure and lower serum concentrations than expected led us to increase the dosage to 10 mg/kg daily for the remaining patients. Tolerability remained excellent. It is concluded that antistaphylococcal treatment for febrile episodes in neutropenic patients can be satisfactorily provided by teicoplanin 10 mg/kg iv daily with a second loading dose on the first day. One injection a day is a convenient schedule in paediatrics.