Yzerman E P, Boelens H A, Vogel M, Verbrugh H A
University Hospital Rotterdam, Dijkzigt, Department of Clinical Microbiology, The Netherlands.
J Antimicrob Chemother. 1998 Aug;42(2):233-9. doi: 10.1093/jac/42.2.233.
An open study was carried out on 16 patients with hospital-acquired, bacteraemic Staphylococcus aureus infections to evaluate the safety and efficacy of teicoplanin plus rifampicin. Patients received teicoplanin 400 mg bd for the first 24 h followed by 400 mg od thereafter, and rifampicin 600 mg bd. Both agents were given intravenously. Serum samples were collected to determine trough and peak antibiotic concentrations. The MIC of teicoplanin and rifampicin and the MBC of teicoplanin were determined for all S. aureus isolates. Time-kill curves were performed for the drugs individually and in combination. Clinical efficacy was assessed by the APACHE II scoring system. Bacteriological success was evaluated by elimination, persistence or recurrence of S. aureus. Safety was carefully monitored by regular biochemical and haematological testing and recording of adverse events. Fifteen patients were evaluable, of whom 13 (86.7%) were clinically cured with elimination of S. aureus. One patient died, but death was not attributed to the study drugs. Treatment failed in another patient who relapsed with a high fever. S. aureus was recovered from blood cultures from this patient, and resistance to rifampicin had developed. Time-kill curves all showed adequate killing of S. aureus at the drug concentrations measured in vivo. Neither synergy nor antagonism between teicoplanin and rifampicin was demonstrated. The combination of teicoplanin and rifampicin is an effective and well-tolerated treatment for bacteraemic S. aureus infections, but in deep-seated foci of infection resistance to rifampicin may develop.
对16例医院获得性金黄色葡萄球菌菌血症感染患者进行了一项开放性研究，以评估替考拉宁联合利福平的安全性和疗效。患者在最初24小时接受替考拉宁400mg，每日两次，此后改为400mg，每日一次，利福平600mg，每日两次。两种药物均静脉给药。采集血清样本以测定抗生素谷浓度和峰浓度。测定所有金黄色葡萄球菌分离株的替考拉宁和利福平的最低抑菌浓度（MIC）以及替考拉宁的最低杀菌浓度（MBC）。分别对两种药物及其联合用药进行了时间杀菌曲线研究。通过急性生理学及慢性健康状况评分系统（APACHE II）评估临床疗效。通过金黄色葡萄球菌的清除、持续存在或复发来评估细菌学疗效。通过定期的生化和血液学检测以及记录不良事件来密切监测安全性。15例患者可进行评估，其中13例（86.7%）临床治愈，金黄色葡萄球菌被清除。1例患者死亡，但死亡并非归因于研究药物。另1例患者治疗失败，出现高热复发。从该患者的血培养中分离出金黄色葡萄球菌，且已产生对利福平的耐药性。时间杀菌曲线均显示在体内测得的药物浓度下对金黄色葡萄球菌有足够的杀灭作用。未显示替考拉宁和利福平之间有协同或拮抗作用。替考拉宁和利福平联合用药是治疗金黄色葡萄球菌菌血症感染的一种有效且耐受性良好的治疗方法，但在深部感染病灶中可能会出现对利福平的耐药性。
