Journal of Antimicrobial Chemotherapy (1996) 37, 209-222
© 1996 The British Society for Antimicrobial Chemotherapy
review-article |
The comparative efficacy and safety of teicoplanin and vancomycin
Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital Birmingham B9 5ST, UK
Received 12 April 1995; returned 25 July 1995; accepted 21 September 1995
Glycopeptide antibiotics, such as teicoplanin and vancomycin, are active against staphylococci (including methicillin resistant strains), streptococci, enterococci and Clostridium spp. Vancomycin and teicoplanin are both widely used in the treatment of infections caused by Gram-positive organisms. Vancomycin can, however, provoke a number of side-effects, and serum concentrations should be monitored during treatment. Teicoplanin has a longer half-life than vancomycin, it can be given as an intravenous bolus or by intramuscular injection, and nephrotoxicity and ototoxicity are relatively uncommon. Treatment with teicoplanin might, therefore, offer advantages over treatment with vancomycin—provided that similar clinical efficacy can be shown. At least 11 clinical trials comparing the efficacy and safety of teicoplanin and vancomycin have been carried out worldwide. Meta-analysis of the combined results from these studies indicates that more than three-quarters of the patients in each of the treatment groups had a clinical response to therapy. Meta-analysis of the numbers of adverse events occurring in each treatment group shows significantly fewer reports of adverse events in patients receiving teicoplanin (13.9%) than in those receiving vancomycin (21.9%). Direct comparisons are difficult because of inherent differences between studies, but available data suggest that teicoplanin is as effective as vancomycin and that its superior tolerability together with advantages such as once-daily bolus administration, intramuscular use and lack of requirement for routine serum monitoring, give it considerable potential for use in clinical practice.
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