Endocarditis teicoplanin

Teicoplanin, although not available in the United States, has been used to treat a wide range of gram-positive infections, including endocarditis and peritonitis. It is not as effective as the (3-lactams, but its actions are similar to those of vancomycin against staphylococcal infections. 

Special risk patients, i.e. with prosthetic valves or with previous endocarditis, should receive amoxicillin 1 g i.m. or i.v. and gentamicin 120 mg at induction, then amoxicillin 0.5 g by mouth 6 h later. Patients who are penicillin-allergic or have received penicillin more that once in the previous month should receive vancomycin 1 g i.v. over 100 min then gentamicin 120 mg i.v. at induction or 15 min before the procedure or teicoplanin 400 mg i.v. plus gentamicin 120 mg i.v, at induction or 15 min before the procedure or clindamycin 300 mg over at least 10 min at induction or 15 min before the procedure then clindamycin 150 mg i.v. or by mouth 6 h later. 

In a prospective, randomized trial in 34 drug abusers a short course of a combination of a glycopeptide (vancomycin or teicoplanin) with gentamicin was significantly less effective in right-sided endocarditis caused by S. aureus than a combination of cloxacilhn and gentamicin (9). 

Rybak MJ, Lerner SA, Levine DP, Albrecht LM, McNeil PL, Thompson GA, Kenny MT, Yuh L. Teicoplanin pharmacokinetics in intravenous drug abusers being treated for bacterial endocarditis. Antimicrob Agents Chemother 1991 35(4) 696-700. 

Voorn GP, Kuyvenhoven J, Goessens WHF, et al. Role of tolerance in treatment and prophylaxis of experimental Staphylococcus aureus endocarditis with vancomycin, teicoplanin, and daptomycin. Antimicrob Agents Chemother 1994 38 487-493. 

Kaaw GW. Seo SM. Dorman NJ. Lemer SA. Emergence of teicoplanin resistance during therapy of Staphylococcus aureus endocarditis. J Infect Dis 1990 162 103-108. 

A 66-year-old woman was treated with 400 mg intravenous teicoplanin for suspected postoperative endocarditis. Eighteen days into treatment she developed fever and neutropenia. The fevers spiked 40 min following administration of teicoplanin. The neutropenia and fever resolved within a few days following cessation of the treatment [66 ]. This case highlights the potential for drug-induced fever as well as neutropenia and must be considered in patients on long-term antibiotics. 

Booth K, Parissis H. Teicoplanin-induced neutropenic sepsis rtiimickmg endocarditis. Asian Cardiovasc Thorac Ann2012 20(4) 460-2. Nannini EC, Corey GR, Stryjewski ME. Telavancin for the treatment of hospital-acquired pneumonia findings from the ATTAIN studies. Expert Rev Anti Infect Ther 2012 10(8) 847-54. 

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