Journal of Antimicrobial Chemotherapy, Vol 42, 233-239, Copyright © 1998 by The British Society for Antimicrobial Chemotherapy
EP Yzerman, HA Boelens, M Vogel and HA Verbrugh
An open study was carried out on 16 patients with hospital-acquired,
bacteraemic Staphylococcus aureus infections to evaluate the safety and
efficacy of teicoplanin plus rifampicin. Patients received teicoplanin 400
mg bd for the first 24 h followed by 400 mg od thereafter, and rifampicin
600 mg bd. Both agents were given intravenously. Serum samples were
collected to determine trough and peak antibiotic concentrations. The MIC
of teicoplanin and rifampicin and the MBC of teicoplanin were determined
for all S. aureus isolates. Time-kill curves were performed for the drugs
individually and in combination. Clinical efficacy was assessed by the
APACHE II scoring system. Bacteriological success was evaluated by
elimination, persistence or recurrence of S. aureus. Safety was carefully
monitored by regular biochemical and haematological testing and recording
of adverse events. Fifteen patients were evaluable, of whom 13 (86.7%) were
clinically cured with elimination of S. aureus. One patient died, but death
was not attributed to the study drugs. Treatment failed in another patient
who relapsed with a high fever. S. aureus was recovered from blood cultures
from this patient, and resistance to rifampicin had developed. Time-kill
curves all showed adequate killing of S. aureus at the drug concentrations
measured in vivo. Neither synergy nor antagonism between teicoplanin and
rifampicin was demonstrated. The combination of teicoplanin and rifampicin
is an effective and well-tolerated treatment for bacteraemic S. aureus
infections, but in deep-seated foci of infection resistance to rifampicin
may develop.
ORIGINAL ARTICLES
Efficacy and safety of teicoplanin plus rifampicin in the treatment of bacteraemic infections caused by Staphylococcus aureus
University Hospital Rotterdam, Dijkzigt, Department of Clinical Microbiology, The Netherlands.
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