ANTI-GRAM-POSITIVE AGENTS - WHAT WE HAVE AND WHAT WE WOULD LIKE

The usefulness of many anti-Gram-positive antibiotics is being comprom ised by the spread of antibiotic resistance in bacteria. The most reli able agents for serious infections are the glycopeptide agents vancomy cin and teicoplanin. The appropriate maintenance dosage for teicoplani n in serious infections is 6 mg/kg/day, i.e. usually 400 mg/day. There are 3 exceptions for which the daily maintenance dosage should be 12 mg/kg/day and these are intravenous drug abusers, septic arthritis (bu t not osteomyelitis), and Staphylococcus aureus endocarditis treated w ith teicoplanin monotherapy. When teicoplanin is given at these doses, it achieves clinical and bacteriological results that are equivalent to those obtained with vancomycin, irrespective of pathogen or type of infection. The toxicity profile favours teicoplanin over vancomycin, especially when other, potentially toxic, drugs are coadministered. Te icoplanin also has an advantage in terms of ease and convenience of ad ministration, which, together with its lack of need for routine blood level monitoring, facilitates its use outside hospital. New agents hol d some promise for the future; however, oral agents, if developed, cou ld present the risk of being overused, which might compromise their lo ng term utility.