MANAGEMENT OF SERIOUS STAPHYLOCOCCAL INFECTIONS IN THE OUTPATIENT SETTING

Patients with serious staphylococcal infections, e.g. endocarditis and osteomyelitis, need prompt and prolonged parenteral antibiotic treatm ent to ensure eradication of the causative pathogen. The major cost in the treatment of these infections is the long period of hospitalisati on required for the administration of intravenous antibiotics. To shor ten the hospitalisation period, outpatient treatment can be given to s ome patients. In this study, patients with acute exacerbations of chro nic osteomyelitis (n = 44) or endocarditis (n = 10) were treated with intravenous teicoplanin. The pathogens were Staphylococcus aureus (n = 41, 13 of which were methicillin resistant) and coagulase-negative st aphylococci (n = 13, one of which was methicillin resistant). After a mean loading dose of 15 mg/kg for 3 to 10 days, patients received teic oplanin 3 times a week at a dose (mean 15 mg/kg) individualised to ach ieve serum trough concentrations of approximately 10 mg/L for osteomye litis and 20 mg/L for endocarditis. Treatment duration ranged from 28 to 150 (mean 62) days for patients with osteomyelitis and from 28 to 8 8 (mean 49) days for patients with endocarditis. 37 (84%) patients wit h osteomyelitis and 8 (80%) patients with endocarditis were treated su ccessfully. Adverse events were observed in 9 patients and included ra sh (n = 3), thrombocytopenia (n = 3), and drug fever, pseudomembranous colitis, nausea, leucopenia and transient hearing impairment (one pat ient each). In conclusion, this study demonstrates that teicoplanin ca n be administered successfully in an outpatient setting according to a 3-times weekly schedule for the treatment of patients with staphyloco ccal osteomyelitis and endocarditis.