ANTIINFECTIVE TREATMENT IN INTENSIVE-CARE - THE ROLE OF GLYCOPEPTIDES

Antibiotics are used in 80% of patients in the ICU, encouraging nosoco mial infections with resistant organisms. If the antibiotic susceptibi lities of the pathogen are known, a narrow-spectrum antiobiotic is pre ferable to preserve the patient's resistance to colonization. However, treatment is often empirical and broad-spectrum combinations are comm only used. Gram-positive bacteraemia is associated with invasive monit oring or intravascular catheters. If the device cannot be removed easi ly, the glycopeptides are the only agents likely to be active against most strains of the commonest pathogen, the coagulase-negative staphyl ococcus. Long-stay patients are susceptible to infection with enteroco cci and methicillin-resistant Staphylococcus aureus, which are often r esistant to all the usual agents other than glycopeptides. Vancomycin is long established, but is nephrotoxic, requires serum monitoring, mu st be administered as an infusion and can cause red man syndrome. Teic oplanin can be given as a single daily bolus without similar side-effe cts or monitoring. In deep-seated staphylococcal infection, the usual dose of teicoplanin is adequate if given in combination with other age nts, but it may need to be doubled if used as monotherapy. Monitoring of the levels in the serum is helpful to ensure an adequate dose in pa tients with renal failure or in drug abusers, but is not needed to pre vent toxicity.