Comparison of efficacy and safety of teicoplanin and vancomycin in children with antineoplastic therapy-associated febrile neutropenia and Gram-positive bacteremia

To compare their efficacy and safety, teicoplanin and vancomycin were rando mly administered to 32 children for 52 Gram-positive bacteremias during mal ignancy-associated neutropenia (<1000/mu l). Patients mainly suffered from hematological malignancies. Twenty-five episodes were treated with teicopla nin (10 mg x kg(-1) x d(-1)) and 21 with vancomycin (40 mg x kg(-1) x d(-1) ) plus ceftazidime and netilmicin. Six episodes were treated with teicoplan in because of previous "red man" reaction to vancomycin. Staphylococci (12% Staphylococcus aureus) were isolated from 50 episodes and viridans strepto cocci from 2, Defervescence on 3(rd)-4(th) day occurred in 29/31 (93.5%) te icoplanin-treated and 18/21 (85.7%) vancomycin-treated episodes. All 12 tei coplanin-treated and 13/13 vancomycin-treated episodes with repeat blood cu ltures on 3(rd)-4(th) day showed microbiological response. Two teicoplanin- treated and 3 vancomycin-treated patients required antifungals. Mild renal insufficiency appeared in 5 vancomycin-treated patients that was corrected without drug discontinuation. While both glycopeptides exhibit equal clinic al and microbiological efficacy, teicoplanin is less likely to induce aller gic reactions or nephrotoxicity in children.