Pittet D, Harding I
Department of Internal Medicine, University Hospital of Geneva, Switzerland.
J Infect. 1998 Sep;37(2):127-35. doi: 10.1016/s0163-4453(98)80166-7.
Despite the number of antibacterial agents currently available, endocarditis remains a difficult disease to treat and the mortality rate has not fallen in recent years. The glycopeptides have good activity against the Gram-positive bacteria commonly implicated in endocarditis (staphylococci, both coagulase-positive and negative; enterococci and streptococci).
To assess the impact of the glycopeptides vancomycin and teicoplanin on the therapy of infectious endocarditis caused by Gram-positive bacteria.
A retrospective review of all major published or recently conducted studies using vancomycin or teicoplanin to treat endocarditis.
Cure rates obtained with vancomycin and teicoplanin are similar, but there are no controlled studies to investigate this. Vancomycin nephrotoxicity limits its use in endocarditis, in particular when used in combination with an aminoglycoside. By contrast, teicoplanin shows little nephrotoxic potential, even in patients with some degree of renal impairment or when given in combination with an aminoglycoside. Teicoplanin should be used at doses of 6 mg/kg/day or higher to achieve satisfactory cure rates.
Clinical data on the use of glycopeptides in endocarditis suffer from a lack of controlled trials. Although teicoplanin appears to offer some advantages over vancomycin in the therapy of endocarditis, there is an urgent need for randomized, clinical trials before definitive conclusions can be drawn.
尽管目前有多种抗菌药物，但心内膜炎仍然是一种难以治疗的疾病，近年来死亡率并未下降。糖肽类药物对心内膜炎中常见的革兰氏阳性菌（葡萄球菌，包括凝固酶阳性和阴性；肠球菌和链球菌）具有良好的活性。
评估糖肽类药物万古霉素和替考拉宁对革兰氏阳性菌引起的感染性心内膜炎治疗的影响。
对所有已发表或最近进行的使用万古霉素或替考拉宁治疗心内膜炎的主要研究进行回顾性分析。
万古霉素和替考拉宁的治愈率相似，但尚无对照研究对此进行调查。万古霉素的肾毒性限制了其在心内膜炎中的应用，尤其是与氨基糖苷类药物联合使用时。相比之下，替考拉宁即使在有一定程度肾功能损害的患者中，或与氨基糖苷类药物联合使用时，肾毒性潜力也很小。替考拉宁应以6mg/kg/天或更高的剂量使用，以达到满意的治愈率。
关于糖肽类药物在心内膜炎中应用的临床数据缺乏对照试验。虽然替考拉宁在心内膜炎治疗中似乎比万古霉素有一些优势，但在得出明确结论之前，迫切需要进行随机临床试验。
