TEICOPLANIN - A REAPPRAISAL OF ITS ANTIMICROBIAL ACTIVITY, PHARMACOKINETIC PROPERTIES AND THERAPEUTIC EFFICACY

Since an earlier review in the Journal substantial additional data hav e accumulated, further clarifying the in vitro activity, pharmacokinet ic profile, clinical efficacy and tolerability of teicoplanin. Recent therapeutic trials confirm the efficacy of teicoplanin in the treatmen t of microbiologically confirmed Gram-positive infections, including s epticaemia, endocarditis, and infections of skin and soft tissue, bone and joints, and the lower respiratory tract. As teicoplanin can be ad ministered once daily intramuscularly as well as intravenously, it has potential for outpatient treatment of severe Gram-positive infections . Teicoplanin is appropriate as treatment of patients with fever and n eutropenia but there is still controversy over the timing for introduc tion of glycopeptide antibiotics into therapeutic regimens. Teicoplani n is generally reserved for secondary therapy of patients with documen ted bacteraemia who fail to respond to initial empirical antibiotic re gimens, but probably should be part of the initial empirical regimen i n the setting of a high incidence of methicillin-resistant staphylococ ci. Teicoplanin has a lower propensity than vancomycin to impair renal function when either drug is combined with an aminoglycoside, causes fewer anaphylactoid reactions, and appears to be of comparable efficac y. Thus, teicoplanin may be preferred to vancomycin in the treatment o f Gram-positive infections, and where a glycopeptide antibiotic is dee med a necessary inclusion in a regimen for empirical treatment in pati ents with fever and neutropenia.