Teicoplanin

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Abstract
Teicoplanin, a glycopeptide antibiotic, is active against Gram-positive organisms, including methicillin-resistant staphylococci. It has demonstrated similar efficacy to vancomycin in the treatment of Gram-positive infections in febrile patients with neutropenia; fewer comparative data are available in patients with other infection types. Compared with vancomycin, teicoplanin is associated with less nephrotoxicity, appears to cause fewer anaphylactoid reactions, requires less monitoring and is more convenient to administer (once daily by intravenous bolus or intramuscular injection vs 2 to 4 times daily by intravenous infusion). Two European cost-minimisation studies have demonstrated that while the acquisition cost per dose of teicoplanin was approximately twice that of vancomycin, the cost of 2 weeks’ therapy with either agent was similar (difference of 1 to 2%). However; in order to fully explore potential differences between these agents, a full economic analysis which considers all treatment-related costs is needed. Home therapy of Gram-positive infections, a setting in which teicoplanin may be preferred over vancomycin because of its tolerability profile and ease of administration, is particularly worthy of future economic study. Thus, there are a number of areas needing further study before the optimum formulary positioning of teicoplanin can be definitely stated. Nevertheless, present evidence suggests that teicoplanin is likely to have pharmacoeconomic advantages over vancomycin in at least some situations. Serious Gram-positive infections are becoming more common and can be costly to treat, especially when antibiotic-resistant pathogens are involved. Nosocomial infections are commonly caused by staphylococci or enterococci, organisms that are increasingly associated with multidrug resistance. Costs incurred in the treatment of Gram-positive infections are similar to those generated by all serious infections requiring administration of parenteral antibacterial therapy. They include both hospitalisation costs (the largest of these being occupation of a hospital bed) and antibacterial therapy costs (such as costs incurred by drug acquisition, preparation, administration and monitoring, treatment of adverse events and treatment failure). Indirect and intangible costs are also generated, although they are often more difficult to quantify. Teicoplanin, a glycopeptide antibiotic, has a similar spectrum of activity to vancomycin. Noncomparative trials have demonstrated the efficacy of teicoplanin in the treatment of Gram-positive infections (such as skin and soft tissue infection, acute or chronic osteomyelitis, septic arthritis, lower respiratory tract infections or bacteraemia) and as empirical therapy in immunocompromised patients with haematological malignancies requiring intensive chemotherapy. In comparative trials, teicoplanin demonstrated similar efficacy to vancomycin in febrile patients with neutropenia. Small patient numbers in studies of other infection types preclude a definitive assessment of the comparative efficacy of these agents. Teicoplanin can be administered once daily by intramuscular or intravenous bolus injection and is suitable for outpatient treatment of Gram-positive infections. Along with acquisition cost, the costs of delivery, monitoring, adverse effects and treatment failure must be considered when determining the total cost of therapy. Teicoplanin has been associated with fewer adverse effects than vancomycin. Vancomycin appears more likely to induce erythema and pruritus of the upper body (‘red man syndrome’), although reports of this effect may have been exaggerated and it can be minimised by prior administration of a histamine H1-receptor antagonist, increasing infusion duration or administration of smaller, more frequent doses of vancomycin. However, these measures increase the administration costs of vancomycin. Drug therapy costs also escalate when therapeutic drug monitoring is necessary. It appears that monitoring of plasma drug concentrations and renal function is recommended for a larger proportion of patients treated with vancomycin than with teicoplanin. The convenient administration schedule of teicoplanin may also compare favourably with vancomycin in terms of costs. Teicoplanin can be administered once daily by intravenous bolus injection, which costs considerably less to deliver than the 2 to 4 daily doses by intravenous infusion required for vancomycin. These attributes also allow teicoplanin to be administered conveniently as home therapy, which can be associated with additional cost savings. In cost-minimisation studies conducted in Europe, 2 weeks of monotherapy with teicoplanin 400mg once daily was only 1 to 2% more expensive than 2 weeks’ treatment with vancomycin 1g twice daily, despite the higher acquisition cost per dose and requirement for an extra loading dose of teicoplanin. These analyses considered direct costs associated with therapy only (acquisition, preparation, administration and monitoring costs). Although limited, 2 analyses comparing home and inhospital treatment with teicoplanin have shown considerable cost savings to payers ($US1000 or $US8000 per patient) with home therapy.
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