TREATMENT OF ENDOCARDITIS WITH TEICOPLANIN - A RETROSPECTIVE ANALYSISOF 104 CASES

Infective endocarditis is an uncommon disease but retains a high morta lity. Glycopeptides are used for patients with resistant pathogens, th ose allergic to penicillins or for those outside the hospital. The onc e daily administration of teicoplanin and its low toxicity suggest tha t it would be suitable for use in the long courses required for endoca rditis. However, the dosage and combinations to be used require furthe r study. A retrospective review has been made of 104 episodes of endoc arditis treated with teicoplanin in 101 patients seen over 7 years. Mo st patients had been referred to major London hospitals following fail ure of medical treatment. After three loading doses of 400 mg, teicopl anin was given at a dose of 400 mg/day in combination with other antib iotics such as gentamicin. Follow up was for one year. The most common pathogens were Streptococcus sanguis (15 cases), Staphylococcus aureu s (13 cases) and Staphylococcus epidermidis (10 cases). Of 80 patients febrile at the start of treatment with teicoplanin, 63 (79%) lost the ir fever within a median of 2 days (1-35 days). Cure without surgery w as effected in 50 (48%) and 75% of patients survived. Other antibiotic s, usually gentamicin or rifampicin, were used in 92 (90%) of patients . Two strains of Streptococcus spp. were said to be resistant but ther e was no relationship between MIC of teicoplanin and outcome. Pathogen s with a high MBC tended to be more likely to resist treatment. Advers e effects resulted in the withdrawal of teicoplanin in 20 cases (19%) but most events were mild and renal deterioration occurred in only fiv e patients. Teicoplanin was effective in the treatment of endocarditis and appeared to be safe given the severity of disease in the patients treated.