Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Nov 3;16(1):622.
doi: 10.1186/s12879-016-1955-7.

Teicoplanin-based antimicrobial therapy in Staphylococcus aureus bone and joint infection: tolerance, efficacy and experience with subcutaneous administration

Olivier Peeters  1   2   3 , Tristan Ferry  1   2   4 , Florence Ader  1   2   4 , André Boibieux  1   2 , Evelyne Braun  1   2 , Anissa Bouaziz  5 , Judith Karsenty  6 , Emmanuel Forestier  7 , Frédéric Laurent  1   4   8 , Sébastien Lustig  1   4   9 , Christian Chidiac  1   2   4 , Florent Valour  10   11   12 ; Lyon BJI study group
Collaborators, Affiliations

Teicoplanin-based antimicrobial therapy in Staphylococcus aureus bone and joint infection: tolerance, efficacy and experience with subcutaneous administration

Olivier Peeters et al. BMC Infect Dis. .

Abstract

Background: Staphylococci represent the first etiologic agents of bone and joint infection (BJI), leading glycopeptides use, especially in case of methicillin-resistance or betalactam intolerance. Teicoplanin may represent an alternative to vancomycin because of its acceptable bone penetration and possible subcutaneous administration.

Methods: Adults receiving teicoplanin for S. aureus BJI were included in a retrospective cohort study investigating intravenous or subcutaneous teicoplanin safety and pharmacokinetics.

Results: Sixty-five S. aureus BJIs (orthopedic device-related infections, 69 %; methicillin-resistance, 17 %) were treated by teicoplanin at the initial dose of 5.7 mg/kg/day (IQR, 4.7-6.5) after a loading dose of 5 injections 12 h apart. The first trough teicoplanin level (Cmin) reached the therapeutic target (15 mg/L) in 26 % of patients, only. An overdose (Cmin >25 mg/L) was observed in 16 % patients, 50 % of which had chronic renal failure (p = 0.049). Seven adverse events occurred in 6 patients (10 %); no predictive factor could be highlighted. After a 91-week follow-up (IQR, 51-183), 27 treatment failures were observed (42 %), associated with diabetes (OR, 5.1; p = 0.057), systemic inflammatory disease (OR, 5.6; p = 0.043), and abscess (OR, 4.1; p < 10-3). A normal CRP-value at 1 month was protective (OR, 0.2; p = 0.029). Subcutaneous administration (n = 14) showed no difference in pharmacokinetics and tolerance compared to the intravenous route.

Conclusions: Teicoplanin constitutes a well-tolerated therapeutic alternative in S. aureus BJI, with a possible subcutaneous administration in outpatients. The loading dose might be increase to 9-12 mg/kg to quickly reach the therapeutic target, but tolerance of such higher doses remains to be evaluated, especially if using the subcutaneous route.

Keywords: Bone and joint infection; Staphylococcus aureus; Subcutanous administration; Teicoplanin.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Comparison of median teicoplanin trough concentrations in intravenously- and subcutaneously-treated patients during the first 2 weeks of treatment. Data are presented as median and interquartile ranges of teicoplanin trough levels available each day after treatment initiation
See this image and copyright information in PMC

References

    1. Tong SYC, Davis JS, Eichenberger E, Holland TL, Fowler VG. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev. 2015;28:603–61. doi: 10.1128/CMR.00134-14. - DOI - PMC - PubMed
    1. Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM, Rao N, Hanssen A, Wilson WR. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2013;56:e1–25. doi: 10.1093/cid/cis803. - DOI - PubMed
    1. Titécat M, Senneville E, Wallet F, Dezèque H, Migaud H, Courcol RJ, Loïez C. Microbiologic profile of Staphylococci isolated from osteoarticular infections: evolution over ten years. Surg Infect. 2015;16:77–83. doi: 10.1089/sur.2013.258. - DOI - PubMed
    1. Valour F, Karsenty J, Bouaziz A, Ader F, Tod M, Lustig S, Laurent F, Ecochard R, Chidiac C, Ferry T. Antimicrobial-related severe adverse events during treatment of bone and joint infection due to methicillin-susceptible Staphylococcus aureus. Antimicrob Agents Chemother. 2014;58:746–55. doi: 10.1128/AAC.02032-13. - DOI - PMC - PubMed
    1. Svetitsky S, Leibovici L, Paul M. Comparative efficacy and safety of vancomycin versus teicoplanin: systematic review and meta-analysis. Antimicrob Agents Chemother. 2009;53:4069–79. doi: 10.1128/AAC.00341-09. - DOI - PMC - PubMed

MeSH terms