Teicoplanin or vancomycin in the treatment of gram-positive infections?

J Clin Pharm Ther. 1995 Feb;20(1):5-11. doi: 10.1111/j.1365-2710.1995.tb00619.x.

Abstract

The glycopeptide antibiotics vancomycin and teicoplanin have similar mechanisms of action on bacterial cell wall synthesis. Their spectra of activity are limited to Gram-positive bacteria, with the degree of bactericidal activity depending on the species of micro-organism. Staphylococcus aureus, Staphylococcus epidermis, enterococci and Clostridium difficile are generally sensitive, including methicillin-resistant strains of S. aureus and S. epidermidis. Glycopeptide resistance has recently emerged in staphylococci and enterococci. Vancomycin has a shorter half-life than teicoplanin and requires multiple dosing to maintain adequate serum levels. It can only be given by prolonged intravenous infusion over 1 h. In contrast, the pharmacokinetics of teicoplanin allow for once-daily dosing, either by rapid intravenous infusion or by the intramuscular route. The latter offers reliable absorption for patients with limited venous access and is also of benefit for out-patient therapy. Teicoplanin is a safer drug than vancomycin. It is associated with a lower incidence of nephrotoxicity or ototoxicity. Compared to vancomycin, the availability of the intramuscular route and the absence of a requirement for routine serum monitoring, together with the reduced need to treat drug-related side-effects make teicoplanin more cost-effective. It is as effective as vancomycin for most indications, is safe, easy to administer and an important agent for treating Gram-positive infections. Its role in hospitals is likely to increase if the price of drug acquisition is kept low.

Publication types

  • Review

MeSH terms

  • Cell Wall / drug effects
  • Cost-Benefit Analysis
  • Drug Resistance, Microbial
  • Gram-Positive Bacteria / drug effects*
  • Gram-Positive Bacterial Infections / drug therapy*
  • Half-Life
  • Humans
  • Teicoplanin / adverse effects
  • Teicoplanin / pharmacokinetics
  • Teicoplanin / pharmacology
  • Teicoplanin / therapeutic use*
  • Vancomycin / adverse effects
  • Vancomycin / pharmacokinetics
  • Vancomycin / pharmacology
  • Vancomycin / therapeutic use*

Substances

  • Teicoplanin
  • Vancomycin