Teicoplanin for therapy of gram-positive infections in neutropenic patients.

Teicoplanin was evaluated in 20 febrile neutropenic patients as additional treatment for suspected Gram-positive infections after inadequate response to initial empiric ceftazidime monotherapy. Five patients with primary septicaemia, four with secondary septicaemia, 12 with localized infections and three with pyrexia of unknown origin were treated with teicoplanin (200 mg bolus intravenously, once daily after a 400 mg loading dose), whilst ceftazidime (2 g, 8-hourly, 30 min infusions) was continued. Four patients were unassessable (tuberculous, viral, protocol violation, and non-infectious pyrexial episode). Clinical cure for the combination was achieved in 11 or the 16 assessable cases (69%). Ten of the eleven (91%) bacteriologically confirmed infections were cured after addition of teicoplanin. Three strains of Staphylococcus aureus, four of Staphylococcus epidermidis (two methicillin resistant), and three strains of Streptococcus faecalis were isolated from successfully treated patients. One patient with Aerococcus and Enterobacter cloacae infection only improved after addition of erythromycin. One superinfection occurred with signs of interstitial pneumonitis in a patient following bone marrow transplantation. Neither ototoxicity nor nephrotoxicity occurred during treatment. A transient rise of liver transaminases was observed in four patients, but was attributable to teicoplanin in only one case. It is concluded that teicoplanin is a potentially effective and well-tolerated antimicrobial agent in neutropenic patients with infections due to Gram-positive organisms.