Teicoplanin or vancomycin in the treatment of Gram–positive infections?

Publisher Website
Google Scholar
Abstract
The glycopeptide antibiotics vancomycin and teicoplanin have similar mechanisms of action on bacterial cell wall synthesis. Their spectra of activity are limited to Gram–positive bacteria, with the degree of bactericidal activity depending on the species of micro–organism. Staphylococcus aureus, Staphylococcus epidermis, enterococci and Clostridium difficile are generally sensitive, including methicillin–resistant strains of S. aureus and S. epidermidis. Glycopeptide resistance has recently emerged in staphylococci and enterococci. Vancomycin has a shorter half–life than teicoplanin and requires multiple dosing to maintain adequate serum levels. It can only be given by prolonged intravenous infusion over 1 h. In contrast, the pharmacokinetics of teicoplanin allow for once–daily dosing, either by rapid intravenous infusion or by the intramuscular route. The latter offers reliable absorption for patients with limited venous access and is also of benefit for out–patient therapy. Teicoplanin is a safer drug than vancomycin. It is associated with a lower incidence of nephrotoxicity or ototoxicity. Compared to vancomycin, the availability of the intramuscular route and the absence of a requirement for routine serum monitoring, together with the reduced need to treat drug–related side–effects make teicoplanin more cost–effective. It is as effective as vancomycin for most indications, is safe, easy to administer and an important agent for treating Gram–positive infections. Its role in hospitals is likely to increase if the price of drug acquisition is kept low.

This publication has 53 references indexed in Scilit: