Aw. Chow et al., TEICOPLANIN VERSUS VANCOMYCIN IN THE EMPIRICAL-TREATMENT OF FEBRILE NEUTROPENIC PATIENTS, European journal of haematology, 51, 1993, pp. 18-24
Gram-positive infections have become prevalent among neutropenic patie
nts with cancer. A prospective, randomized, double-blind trial of teic
oplanin, 6 mg/kg every 12 h for three doses then every 24 h, versus va
ncomycin hydrochloride, 15 mg/kg every 12 h, in the empirical treatmen
t of febrile neutropenic patients was undertaken among 50 consecutive
patients with haematological malignancy. The patients also received pi
peracillin 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 compar
able in age, sex, renal function, underlying disease and concurrent th
erapy. Among 22 patients (44%) with culture-proven infection, Gram-pos
itive organisms were isolated in 15 (9 with bacteraemia) and Gram-nega
tive in 11 (4 with bacteraemia). Mixed or polymicrobial infection occu
rred in 8 patients. Serum 1-h peak and trough levels at steady state w
ere 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 eliminatio
n half-life and apparent volume of distribution at steady state were 8
0.5+/-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 succ
essful 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 effe
cts was also more common among vancomycin patients (10 versus 2; p=0.0
2). Concurrent treatment with cyclosporin A and vancomycin, but not wi
th cyclosporin A and teicoplanin, resulted in significant renal dysfun
ction (p=0.02). At the dose employed, teicoplanin was tolerated better
than vancomycin in the empirical treatment of fever and neutropenia.