Teicoplanin in cardiac surgery: intraoperative pharmacokinetics and concentrations in cardiac and mediastinal tissues.

The concentrations of teicoplanin in the sera and mediastinal and heart tissues of 23 patients undergoing cardiac surgery were measured after two regimens of teicoplanin administration. Intraoperative pharmacokinetic parameters were also obtained. Patients were randomized into two groups. Those in group 1 were given teicoplanin at 6 mg x kg(-1) intravenously at the time of induction of anesthesia. Patients in group 2 were given teicoplanin at 12 mg x kg(-1) during the same period. The maximum concentration in serum (71 +/- 20 and 131 +/- 44 mg x l(-1)), the minimum concentration in serum (3.6 +/- 1.3 and 6.8 +/- 2.1 mg x l(-1)), the area under the concentration-time curve (AUC) from 0 to 12 h (108 +/- 20 and 217 +/- 38 microg x h x ml(-1)), and the AUC from 0 h to infinity (154 +/- 36 and 292 +/- 77 microg x h x ml(-1)) were twice as high after 12-mg x kg(-1) injections as after 6-mg x kg(-1) injections. No differences in mean residence time (9.7 +/- 4.9 and 8.4 +/- 2.7 h) or terminal half-life (8.5 +/- 3.8 and 7.5 +/- 2.3 h) were observed. Teicoplanin penetrated mediastinal and heart tissues but not sternal bone, where the antibiotic was detectable in only 1 of 13 patients in group 1 and 2 of 10 patients in group 2. In group 1, 7 of 13 patients had teicoplanin concentrations in tissue that were lower than the MIC for 90% of the strains of potential pathogens tested (MIC90) that cause infection after cardiac surgery. All of the patients in group 2 but one had teicoplanin concentrations in tissue (other than in sternal bone) far in excess of the MIC90 for the potential pathogens. In conclusion, the 12-mg x kg(-1) regimen of teicoplanin is followed by a significant increase in teicoplanin concentrations in heart and mediastinal tissues and should be preferred to the 6-mg x kg(-1) regimen if teicoplanin is selected for antimicrobial prophylaxis in open heart surgery.

Treatment of 112 bone and joint infections with teicoplanin.

Teicoplanin was used in three hospitals over 6 years in 112 cases of bone or joint infection and the results were reviewed retrospectively. Teicoplanin was used at a dose of 400 mg/day, after a 3-day loading regimen, in combination with other agents, usually netilmicin at the beginning of the treatment. Most infections were chronic (mean duration = 20.9 months) and had failed previous antibiotic or surgical treatment. Gram-positive organisms were isolated in 120/137 identified strains (64 methicillin-resistant Staphylococcus aureus or coagulase négative Staphylococci) and all were susceptible to teicoplanin except one (intermediate for NCCLS norms). Median of follow-up was 17.3 months. The final outcome was clinical cure in 89/98 evaluable cases (91%). There were one improvement, four failures and four recurrences. Adverse events occurred in 11 patients (10%) but did not require any change in treatment. Despite the limitations of a retrospective study, teicoplanin appeared to be effective, well tolerated and easy to use with only one daily injection.RéSUMé: Une étude rétrospective, non comparative, de l'utilisation de la teicoplanine sur 112 cas d'infection ostéo-articulaire pendant 6 ans dans trois hopitaux Français est rapportée. La teicoplanine a été utilisée à la dose de 400 mg/j, après une dose de charge de 3 jours, en association avec d'autres antibiotiques (le plus souvent la netilmycine en début de traitement). Ces infections étaient chroniques (durée d'évolution moyenne de 20,9 mois) et avaient déjà fait l'objet de traitements antérieurs médicaux ou chirurgicaux. Cent vingt cocci gram positif étaient retrouvés sur les 137 souches isolées (64Staphylococus Aureus ou Epidermidis résistant à la methicillin) et tous sauf une (intermédiaire selon les normes NCCLS) étaient sensibles à la teicoplanine. Après une durée de suivi moyenne à 17,3 mois, 89 des 98 cas evaluables (91 %) étaient considérés comme guéris. On retrouvait également 1 amélioration, 4 échecs et 4 récurrences. Un effet secondaire a été noté chez 11 patients (10 %) mais n'a jamais necessité un changement de traitement témoignant ainsi de la bonne tolérance observée avec cette molécule facile à utiliser gràce à une seule injection par jour.