摘要:

Abstract: The widespread use of indwelling catheters and successful antibiotic treatment of Gram‐negative infections has led to an increase of Gram‐positive infections in severely neutropenic patients;Staphylococcus epidermidisis predominant in these infections. The problems associated with the use of vancomycin in treating such infections can be overcome by the glycopeptide antibiotic teicoplanin. It is as effective as vancomycin, but does not cause “red man” syndrome, is uncommonly nephrotoxic, can be given as a rapid bolus once daily, and routine serum monitoring is not required. Other approaches to reducing catheter‐related infections include improved training of personnel in catheter insertion and the development of new materials and methods in cannula

ISSN:0902-4441    

DOI:10.1111/j.1600-0609.1993.tb01898.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract: In all, 88 patients with haematological malignancies requiring Hickman catheters for intensive chemotherapy were randomized to receive either one single bolus intravenous injection of teicoplanin, 400 mg, or no teicoplanin immediately before insertion of a double‐lumen Hickman catheter. Lower incidences of catheter‐related Gram‐positive sepsis were recorded in patients receiving prophylactic teicoplanin; exit site infection, tunnel infection and catheter‐related Gram‐positive septicaemia were all reduced. The benefit of prophylactic teicoplanin was observed particularly among patients who were already neutropenic at the time of catheterization. All Gram‐positive organisms isolated from infected skin sites or from blood cultures taken from Hickman catheters were susceptible to teicoplanin. No adverse reaction was reported in any of the patients receiving prophylaxis. Prophylactic teicoplanin, therefore, may be used routinely for patients requiring insertion of Hickman catheters for intensive chemotherapy, to reduce the early incidence of catheter‐related sepsis, particularly during the period of neutropenia followi

ISSN:0902-4441    

DOI:10.1111/j.1600-0609.1993.tb01899.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract: Children discharged in the terminal phase of illness were offered the possibility of having central venous line infections treated with teicoplanin at home by their parents after suitable instruction. The decision to begin antibiotic treatment was subjective, based on a history of rigors and/or raised temperature in an otherwise “well” child. No difficulties were encountered in instructing the chosen parents. In all, five treatment periods of 7 days were required in the five children selected. The review time was 31 weeks (mean duration, 6.2 weeks/patient; range, 4–12 weeks), ended in all cases by death. Infection occurred a mean of 3.2 weeks after discharge (range, 1–8 weeks), and all episodes were successfully treated at home without hospital admission or ward‐based support. No deaths occurred as a result of antibiotic therapy failure, and there were no clinically relevant side‐effects. Autopsy confirmed the absence of central venous line infection in one patient, but blood culture was positive forStaphylococcus aureusin another. This study shows that home treatment of line infections with teicoplanin is effective and well tolerated, and offers advantages in terms of quality of life and parent‐chil

ISSN:0902-4441    

DOI:10.1111/j.1600-0609.1993.tb01900.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract: Gram‐positive infections have become prevalent among neutropenic patients with cancer. A prospective, randomized, double‐blind trial of teicoplanin, 6 mg/kg every 12 h for three doses then every 24 h, versus vancomycin hydrochloride, 15 mg/kg every 12 h, in the empirical treatment of febrile neutropenic patients was undertaken among 50 consecutive patients with haematological malignancy. The patients also received piperacillin sodium, 3 g every 4 h, and tobramycin sulphate, 1.5–2 mg/kg every 8 h. Both groups (25 teicoplanin and 25 vancomycin) were comparable in age, sex, renal function, underlying disease and concurrent therapy. Among 22 patients (44%) with culture‐proven infection, Gram‐positive organisms were isolated in 15 (9 with bacteraemia) and Gram‐negative in 11 (4 with bacteraemia). Mixed or polymicrobial infection occurred in 8 patients. Serum 1‐h peak and trough levels at steady state were 41 ± 15 and 12 ± 3 mg/l for teicoplanin (at 14 ±4 days), and 40 ± 10 and 8 ± 5 mg/l for vancomycin (at 0.9 ± 0.6 days). Mean elimination half‐life and apparent volume of distribution at steady state were 80.5 ± 21.5 h and 1.4 ± 0.8 l/kg for teicoplanin, and 5.6 ± 1.8 h and 0.6 ± 0.2 l/kg for vancomycin. Empirical antimicrobial therapy was successful in 23 teicoplanin and 21 vancomycin patients, respectively (p = 0.67; two‐tailed Fisher's exact test). Nephrotoxicity (serum creatinine>110 mmol/l), however, was more common among vancomycin patients (10 versus 2; p = 0.02), while termination of treatment due to adverse effects was also more common among vancomycin patients (10 versus 2; p = 0.02). Concurrent treatment with cyclosporin A and vancomycin, but not with cyclosporin A and teicoplanin, resulted in significant renal dysfunction (p = 0.02). At the dose employed, teicoplanin was tolerated better than vancomycin in the empirical treat

ISSN:0902-4441    

DOI:10.1111/j.1600-0609.1993.tb01901.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Abstract: The spectrum of microorganisms responsible for infection in neutropenic patients has changed in the last decade, with Gram‐positive organisms now predominant. New antibiotic strategies have been required and have evolved to cope with this change. In particular, the optimal timing of glycopeptide antibiotic use has been addressed. Both teicoplanin and vancomycin are highly effective agents for susceptible Gram‐positive organisms. Teicoplanin has advantages in terms of ease of administration and lower toxicity, while vancomycin has proved durable over many years' use. There are now firm indications for the use of glycopeptide antibiotics in febrile neutropenic patients, including clinically defined central venous catheter infection and microbiologically documented infection with susceptible organisms. The empirical use of the glycopeptide antibiotics in combination with other agents as first‐line treatment, however, is less certain. The utility of this approach remains controversial and ultimately depends on the extent to which local practice favours the emergence of Gram‐positive infections in neutropenic

ISSN:0902-4441    

DOI:10.1111/j.1600-0609.1993.tb01902.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY