A survey of the use of teicoplanin in patients with haematological malignancies and solid tumours

Abstract

A significant number of open and comparative studies have now addressed the use of teicoplanin in the treatment of documented or presumed infection in patients with haematological and non-haematological malignancy. Available evidence suggests that teicoplanin is an effective agent against such infections, with an excellent safety profile. The use of teicoplanin and vancomycin may be justified as part of the initial management of clinically infected right atrial catheters in patients with malignancy. The first-line use of glycopeptides may also be appropriate in units where streptococcal and methicillin resistant staphylococcal infections are prevalent. However, such a policy should be reviewed regularly. Except in the above situations, a delay in the introduction of either teicoplanin or vancomycin in cancer patients does not appear to produce any excess mortality, but there may be some additional morbidity in terms of fever and malaise. The introduction of glycopeptides as second-line agents is indicated for sensitive, microbiologically documented infections and for patients who have not responded to empirical, first-line therapy. Non-inpatient treatment with teicoplanin is an area of ongoing interest and may be justified on both humanitarian and pharmacoeconomic grounds. The use of glycopeptides in the prophylactic setting remains controversial and should be avoided while the emergence of resistance, particularly in enterococci, should be monitored closely.

Diagnosis and treatment of catheter-related infections in paediatric oncology: an update

“…Some Staphylococcus haemolyticus isolates show reduced susceptibility to teicoplanin (MIC > 4 mg/L) or are teicoplanin‐resistant (MIC > 16 mg/L) [133–136], but our own paediatric oncology department has not observed a shift in sensitivity among the Gram‐positive pathogens isolated from CVAD‐related infections, despite use of teicoplanin for > 10 years. Many paediatric oncology centres in Europe prefer to use teicoplanin, since it is as effective as and less toxic than vancomycin [137–141], needs no trough level determination to prevent nephrotoxic or ototoxic adverse events [131,136], and does not cause ‘red‐man syndrome’ if it is administered in < 60 min [142,143]. Another obvious advantage is the standard practice of administering teicoplanin once‐daily after the first two doses (administered every 12 h).…”