The efficacy of teicoplanin in the treatment of endocarditis caused by gram-positive bacteria.

Twenty-six patients with endocarditis caused by Streptococcus viridans (n = 12), Enterococcus faecalis (n = 5), Streptococcus bovis (n = 2), Staphylococcus aureus (n = 3) and Staphylococcus epidermidis (n = 4) were treated with teicoplanin at a dose of 600 mg/day in patients with normal renal function (creatinine clearance 80-120 mL/min) and at a dose of 400 mg/day in patients with moderately impaired renal function (creatinine clearance < 75 mL/min). In nine patients valve replacements were performed. Twenty-one patients were cured by medical treatment with teicoplanin, five patients had a surgical intervention during treatment which was subsequently stopped. Overall, eighteen patients with native valve endocarditis were cured. Out of eight patients with prosthetic valve endocarditis six patients were cured. In one patient teicoplanin therapy was withdrawn because of clinical failure. One patient had a clinical relapse. All cultures taken from blood, endocardium and excised artificial valves were sterile after a minimum of seven days therapy. Side effects were seen in seven patients and included a moderate increase in liver enzymes and mild leucopenia. No renal toxicity was observed, trough serum levels of teicoplanin were not correlated with renal function, a slight accumulation of teicoplanin on day 28 being seen. Our study confirms that teicoplanin is effective as single agent therapy in the treatment of endocarditis due to Gram-positive bacteria.