Davies J M
Department of Haematology, University Hospital, Nottingham, UK.
Eur J Haematol Suppl. 1998;62:2-5. doi: 10.1111/j.1600-0609.1997.tb01701.x.
Factors determining the change in patterns of antibiotic use in patients with haematological malignancies include the growing numbers of infections caused by Gram-positive pathogens, the increasing reliance on indwelling catheters, and strategic movement away from inpatient therapy towards day-case and non-inpatient therapy. The suitability of teicoplanin in this context is examined. The indications for teicoplanin use are now established as: early use in clinically infected patients; as a second-line agent for sensitive pathogens; and in primary antibiotic failures. Teicoplanin should not be used as empirical therapy in fevers of unknown origin; neither should teicoplanin be used as prophylaxis (the situations of infection in chemotherapy patients or for Hickman catheter insertion in particular are discussed). Comparative studies versus vancomycin have shown teicoplanin to be equally effective and to be well tolerated. Teicoplanin's good safety profile and ease of use make it particularly useful for non-inpatient therapy. Problems are posed for both glycopeptides by specific resistant pathogens, although these pathogens are currently not common. Haematologists must be aware of, and guard against, abuse of the glycopeptides in their own and other fields, including oral gut decontamination, the treatment of Clostridium difficile and veterinary use.
影响血液系统恶性肿瘤患者抗生素使用模式变化的因素包括革兰氏阳性病原体引起的感染病例增多、对留置导管的依赖增加，以及从住院治疗向日间病例和非住院治疗的策略性转变。本文探讨了替考拉宁在此背景下的适用性。目前已确定替考拉宁的使用指征为：在临床感染患者中早期使用；作为敏感病原体的二线药物；以及用于原发性抗生素治疗失败的情况。替考拉宁不应作为不明原因发热的经验性治疗药物；也不应作为预防性用药（特别讨论了化疗患者的感染情况或希克曼导管插入术的情况）。与万古霉素的对比研究表明，替考拉宁同样有效且耐受性良好。替考拉宁良好的安全性和易用性使其特别适用于非住院治疗。特定的耐药病原体给两种糖肽类抗生素都带来了问题，尽管这些病原体目前并不常见。血液科医生必须意识到并防范在自身及其他领域滥用糖肽类抗生素的情况，包括口服肠道去污、艰难梭菌的治疗以及兽用。
