Background: Glycopeptides are often used for persistent fever in neutropenic patients. This study compares efficacy and toxicity of teicoplanin and vancomycin.
Patients and methods: Hundred consecutive neutropenic patients with hematological malignancies and persistent fever after 72 h of first-line antibiotic therapy (91% piperacillin/tazobactam) were treated with teicoplanin (800 mg on day 1, then 400 mg/day)+piperacillin/tazobactam+gentamicin from 08/96 to 09/00 (group T) or with vancomycin (2 g/day)+meropenem+levofloxacin from 10/00 to 04/02 (group V). Success was defervescence (>or=7 days) in absence of any sign of continuing infection. Nephrotoxicity was monitored daily as increase in serum creatinine.
Results: Fifty patients were analyzed in each group. Efficacy was evaluated in patients with piperacillin/tazobactam as first-line therapy only. Treatment was successful in 76% in group T (n=42) and 59% in group V (n=49), p=0.118. Toxicity was evaluated in all patients. The median increase of creatinine was 11% (interquartile range 0%-30%) in group T and 17% (0%-74%) in group V, p=0.062. In patients who received concomitant amphotericin B (given for 7 days and 6 days, respectively, p=0.525), median creatinine increased from 0.9 mg/dl (0.8-1.1) to 1.2 mg/dl (0.9-1.5) in group T and from 0.9 mg/dl (0.8-1.08) to 1.55 mg/dl (1.33-2.23) in group V (p<0.001). This led to a doubling of creatinine in 2/23 (9%) patients of group T and in 9/16 (56%) patients of group V (p=0.003). A multivariate analysis revealed that concomitant use of amphotericin B (p<0.001) and treatment with vancomycin (p=0.002) were independently associated with nephrotoxicity.
Conclusion: Teicoplanin and vancomycin were comparably effective in patients with neutropenia and persistent fever, but - if combined with amphotericin B - vancomycin was significantly more nephrotoxic than teicoplanin.