Safety and efficacy of teicoplanin for bone and joint infections: results of a community-based trial.

To evaluate the efficacy and safety of teicoplanin in the treatment of gram-positive bone and joint infections, parenteral teicoplanin was used once daily in an average dose of 10.1 mg/kg (range 6 to 12 mg/kg) after loading to treat patients with acute or chronic osteomyelitis and septic arthritis. From the 66 patients who met criteria for initial enrollment, 60 gram-positive isolates were recovered from bone and joint fluid, and each was sensitive to teicoplanin at < or = 2 micrograms/mL (median 0.25 microgram/mL). Teicoplanin was more active in vitro against these isolates than either vancomycin or oxacillin. Among the 43 patients in whom microbiologic efficacy could be assessed, the initial pathogen was eradicated in 37 (86%). Clinically, 45 patients infected with staphylococci (including oxacillin-susceptible and oxacillin-resistant Staphylococcus aureus and coagulase-negative staphylococci) met predetermined criteria for completed adequate therapy. Of these, 39 (87%) responded favorably and became free of all signs of infection; 6 (13%) failed to respond or suffered relapse. Overall, 36 patients completed teicoplanin therapy at home. Adverse reactions necessitated discontinuance of therapy in 12 patients and included fever, rash, hepatic function test abnormalities, and renal insufficiency. We found teicoplanin to be effective and generally well tolerated for treatment of bone and joint infections by gram-positive organisms in a community setting.