Davies J M
Dept. of Clinical and Laboratory Haematology, Queens Medical Centre, University Hospital, Nottingham, UK.
Infection. 1998 Nov-Dec;26(6):389-95. doi: 10.1007/BF02770842.
A significant number of open and comparative studies have now addressed the use of teicoplanin in the treatment of documented or presumed infection in patients with haematological and non-haematological malignancy. Available evidence suggests that teicoplanin is an effective agent against such infections, with an excellent safety profile. The use of teicoplanin and vancomycin may be justified as part of the initial management of clinically infected right atrial catheters in patients with malignancy. The first-line use of glycopeptides may also be appropriate in units where streptococcal and methicillin resistant staphylococcal infections are prevalent. However, such a policy should be reviewed regularly. Except in the above situations, a delay in the introduction of either teicoplanin or vancomycin in cancer patients does not appear to produce any excess mortality, but there may be some additional morbidity in terms of fever and malaise. The introduction of glycopeptides as second-line agents is indicated for sensitive, microbiologically documented infections and for patients who have not responded to empirical, first-line therapy. Non-inpatient treatment with teicoplanin is an area of ongoing interest and may be justified on both humanitarian and pharmacoeconomic grounds. The use of glycopeptides in the prophylactic setting remains controversial and should be avoided while the emergence of resistance, particularly in enterococci, should be monitored closely.
现在有大量的开放性和对照性研究探讨了替考拉宁在治疗血液系统和非血液系统恶性肿瘤患者确诊或疑似感染中的应用。现有证据表明，替考拉宁是治疗此类感染的有效药物，安全性良好。在恶性肿瘤患者临床感染的右心房导管初始处理中，使用替考拉宁和万古霉素可能是合理的。在链球菌和耐甲氧西林葡萄球菌感染流行的科室，糖肽类药物的一线使用可能也是合适的。然而，这种策略应定期审查。除上述情况外，在癌症患者中延迟使用替考拉宁或万古霉素似乎不会导致任何额外的死亡率增加，但可能会在发热和不适方面增加一些发病率。对于敏感的、微生物学确诊的感染以及对经验性一线治疗无反应的患者，应使用糖肽类药物作为二线药物。替考拉宁的非住院治疗是一个持续受到关注的领域，从人道主义和药物经济学角度来看可能是合理的。糖肽类药物在预防方面的使用仍存在争议，应避免使用，同时应密切监测耐药性的出现，尤其是肠球菌中的耐药性。
