INTRAVENOUS TEICOPLANIN DOES NOT PREVENT CLOSTRIDIUM-DIFFICILE-ASSOCIATED DIARRHEA

A 59-year-old man with the diagnosis of endocarditis of the mitral val ve due to Streptococcus mitis was treated with penicillin G, gentamici n, and later with clindamycin as inpatient for 3 weeks. Thereafter out patient therapy with parenteral teicoplanin 3 x per week was initiated . After 17 days of teicoplanin treatment he developed severe diarrhea, and stool samples were positive for Clostridium difficile toxin. In a ddition to the ongoing parenteral therapy with teicoplanin, oral teico planin was administered. On the third day of this regimen the diarrhea and other disabling symptoms subsided, and test results for C. diffic ile toxin became negative. Oral teicoplanin was continued for 10 days and cleared C. difficile effectively after treatment as assessed by co nsecutive stool cultures (until 60 days thereafter). The parenteral ad ministration of teicoplanin could not prevent the onset of C. difficil e associated diarrhea in this patient, who previously had been treated with clindamycin. Thus, the administration of parenteral teicoplanin does not seem to be a treatment option for C. difficile associated dia rrhea in patients in which oral therapy is not possible.