Quantitative determination of individual teicoplanin components in human plasma and cerebrospinal fluid by high-performance liquid chromatography with electrochemical detection.

We have developed a simple, rapid and highly sensitive method for determining a plasma or cerebrospinal fluid (CSF) concentrations of individual teicoplanin components using reversed-phase high-performance liquid chromatography followed by electrochemical detection. A linear relationship was observed between concentrations and peak heights for the teicoplanin concentration range of 0.025-10microg/mL. The correlation coefficients of all standard curves were greater than or equal to 0.999. The limit of detection for the major component of teicoplanin was 1.0ng/mL (signal/noise ratio >3). Daily fluctuations of standard curves (n=5) were small, with coefficients of variation of 3.3%. The intra-assay precision was 5.9% (n=5). Inter-assay precision ranged from 2.6 to 6.8%. The method described here is suitable for clinical monitoring of teicoplanin levels in plasma or CSF level and for use in studies involving pharmacokinetics of individual teicoplanin component.

[The efficacy of intraventricularly administered vancomycin in the case of central nervous system infection caused by enterococcus faecalis]. / Skutecznosc wankomycyny stosowanej dokomorowo w zakazeniu osrodkowego ukladu nerwowego wywolanego przez Enterococcus faecalis.

The case of 40 years old man with subarachnoid hemorrhage with intraventricular bleeding and with consecutive cerebro-meningitis is presented. The bacterial pathogen was Enterococcus faecalis sensitive only to glycopeptide antibiotics. The standard therapy with intravenously administered Vancomycin and Teicoplanin was not effective. Because of the worsening of patient's clinical status and clinical symptoms of sepsis the intraventricular Vancomycin (20 mg/day) was introduced. At the second day of the therapy the gradual patient's recovery was observed. The symptoms typical for meningitis diminished as well as cerebro-spinal fluid (CSF) parameters normalized. There was no bacterial growth in the blood serum and in CSF. As we can observe the intraventricular administration of Vancomycin is efficient method of cerebro-meningitis treatment. In our opinion the blood-brain barrier, even pathologically changed by infection, do not allow antibiotics to penetrate CSF, even in the maximal intravenous doses. In the cases of cerebro-meningitis caused by bacteria sensitive only to glycopeptide antibiotics, the intraventricular administration of the drug might be an alternative way of therapy especially when the doses of intravenous antibiotics need to be reduced.

[Adequate intrathecal diffusion of teicoplanin after failure of vancomycin, administered in continuous infusion in three cases of shunt associated meningitis]. / Diffusion intrathécale efficace de la teicoplanine aprés échec de la vancomycine, administrées en perfusion continue, dans trois cas de méningite sur shunt.

Glycopeptides which have excellent in vitro activity against the Gram-positive causal agents of meningitis unfortunately have a poor CSF penetration. Vancomycin distribution into CSF is improved when administered by a continuous intravenous route and staphylococcal shunt related infection have been reported to be cured. Teicoplanin has good in vitro activity against a lot of staphylococci, and activity superior to vancomycin, against streptococci and is less toxic. In three children with shunt ventriculitis (S epidermidis 2, S. faecalis 1) despite a continuous infusion, vancomycin 15 mg/kg over 60 minutes onset, then 50 mg/kg/day was clinically and bacteriologically ineffective with very poor CSF levels even if high blood levels. After failure of vancomycin we used teicoplanin as a continuous i.v. infusion 6 mg/kg over 60 mn onset, then 12 mg/kg/day. This treatment was quickly effective and well tolerated.

Successful treatment of meningitis due to multiply resistant Enterococcus faecium with a combination of intrathecal teicoplanin and intravenous antimicrobial agents.

Following neurosurgery necessitated by intractable seizures, Enterococcus faecium meningitis that was resistant to ampicillin, a high-level aminoglycoside (MIC, > 2,000 micrograms/mL), and vancomycin developed in a 6-year-old boy. Treatment with intrathecal teicoplanin in combination with intravenous clindamycin, rifampin, and ampicillin was successful. The role of intravenous and intrathecal antibiotics in treatment of this infection is discussed. This case is illustrative of the safety and potential usefulness of intrathecally administered teicoplanin.