Teicoplanin adverse effects

The major adverse effect associated with vancomycin therapy is ototoxicity, which may result in tinnitus, high-tone hearing loss, and deafness in extreme instances. More commonly, the intravenous infusion of vancomycin can result in chills, fever, and a maculopapular skin rash often involving the head and upper thorax (red man syndrome). Red man syndrome is associated with increased levels of serum histamine. Vancomycin is rarely nephrotoxic when used alone. Teicoplanin rarely causes red man syndrome or nephrotoxicity. 

Cell wall agents, such as glycopeptides, have concentration-independent bactericidal activity, and the time over which the antibiotic serum concentration persists over the minimal inhibitory concentration of the pathogen is a main pharmacodynamic determination of the outcome. In a two-way, randomized, open, two-period, crossover study in 10 healthy adults, teicoplanin given in two 200 mg doses intramuscularly produced steady-state trough concentrations even higher than those after once-daily intravenous administration of 400 mg (3). Conversion from intravenous to intramuscular administration may therefore allow better compliance with preserved efficacy. Intramuscular teicoplanin was well tolerated. Adverse effects reported were mild local pain for 2-3 hours, headache, and backache. 

In 76 patients receiving long-term teicoplanin for chronic osteomyelitis due to oxacillin-resistant Staphylococcus aureus, teicoplanin had to be withdrawn in only one subject because of low-grade fever, muscular pain, and sleeplessness these adverse effects abated after withdrawal (4). 

The overall rate of hematological adverse effects of teicoplanin was 2.2% in 1431 patients participating in a large non-comparative multicenter study (22). 

In a study of the effects of teicoplanin (6-12 mg/day intravenously), 166 of 342 patients reported one or more adverse events, and in 119 they were thought to be associated with teicoplanin (2). Most had some form of hypersensitivity response (fever, rash, chills, or pruritus), and treatment was withdrawn in 59 patients. There was a clinically significant abnormality of liver function tests in 123 patients, but in only 33 was it judged to be possibly associated with teicoplanin. There was a rise in serum creatinine in 28 patients, in five of whom an association with teicoplanin was suggested. 

The most common adverse events associated with teicoplanin are hypersensitivity, fever, rash, diarrhea, nephrotoxicity, and thrombocytopenia (12,13). Local reactions at the injection site include pain, redness, or discomfort after intramuscular injection, or phlebitis after intravenous injection. Erythroderma has occurred during infusion of teicoplanin with fever and hypotension. Allergic reactions have been reported with teicoplanin, with cross-reactivity between teicoplanin and vancomycin documented by in vitro studies showing IgE release by basophils in response to stimulation by both vancomycin and teicoplanin. However, known hypersensitivity to vancomycin is not a contraindication to teicoplanin. Tumor-inducing effects have not been reported. 

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