CHEMOTHERAPY

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Transcription:

CHEMOTHERAPY

VOL.41 S-2 Laboratory and clinical evaluation of teicoplanin

CHEMOTHERAPY AUG. 1993

VOL.41 S-2 Laboratory and clinical evaluation of teicoplanin Table 1. Comparative in vitro activity of teicoplanin and other antibiotics

CHEMOTHERAPY AUG. 1993 Table 2. Comparative in vitro activity of teicoplanin and other antibiotics against methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) *: Resistant strain teicoplanin, vancomycin, minocycline, erythromycin, clindamycin, gentamicin: MIC>6.25 ug/ml. -lactam antibiotics (ampicillin Ĉ methicillin, cefotiam), ofloxacin: MIC>12.5,, cefazolin, ug/ml. **: Highly resistant strain teicoplanin, -lactam vancomycin, antibiotics: ofloxacin, MIC>100ug/ml minocycline, erythromycin, clindamycin, gentamicin: MIC? 100ug/ml. Ĉ.

VOL.41 S-2 Laboratory and clinical evaluation of teicoplanin Fig. 1. Serum concentration after intravenous administration of 200mg of teicoplanin in case, No.3, 82 y. o. female with empyema caused by methicillin-resistant Staphylococcus aureus

CHEMOTHERAPY AUG. 1993

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CHEMOTHERAPY Table 5. Comparative in vitro activity of teicoplanin and other antibiotics against vancomycin-resistant Staphylococcus aureus

Laboratory and clinical evaluation of teicoplanin E, Randisi E and Scotti R. Teichomycin: in vitro and in vivo evaluation in comparison with other antibiotics. J Antimicrob Chemother 11: 419-425,1983 6) Neu H C, and Labthavikul P : In vitro activity of teichomycin compared with those of other antibiotics. Antimicrob Agents Chemother 24: 425-428, 1983

Laboratory and clinical evaluation of teicoplanin Yoshiaki Utsunomiya, Keizo Matsumoto, Tsuyoshi Nagatake, Hironori Masaki, Moritoshi Akiyama, Atsushi Takahashi and Kiwao Watanabe Department of Internal Medicine, Institute of Tropical Medicine, Nagasaki University 1-12-4 Sakamoto, Nagasaki 852, Japan Toshiaki Yoshida Department of Internal Medicine, Nagasaki Rosai Hospital Tasuku Sakamoto and Naoto Rikitomi Department of Internal Medicine, Aino Memorial Hospital Masakazu Takasugi Department of Internal Medicine, Tagami Hospital Harumi Shishido Department of Respiratory Diseases, Tokyo National Hospital We evaluated in vitro activities and pharmacokinetics of teicoplanin (TEIC), a new glycopeptide antibiotic, and its clinical efficacy in 4 patients with gram-positive bacterial infections. The MIC90 against Streptococcus pneumoniae (32 strains), Streptococcus pyogenes (15 strains), Streptococcus agalactiae (8 strains), Enterococcus faecalis (30 strains) and a-streptococci (25 strains) were 0.2 Đg/ml, 0.78 Đg/ml, 0.39 Đg/ml, 1.56 Đg/ml and 0.39 Đg/ml, respectively. The MIC90 against Haemophilus influenzae (45 strains) and Branhamella catarrhalis (37 strains) were > 100 pg/ml and 25 Đg/ml, respectively. The MIC90 against methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA) were 0.78 Đg/ml and 0.78 Đg/ml in period I (April 1982 March 1983, MSSA 50 strains and MRSA 29 strains). The MIC90 against MSSA and MRSA were 0.39 Đg/ml and 0.39 Đg/ml in period II (January 1988 March 1988, MSSA 29 strains and MRSA 33 strains), 0.78 Đg/ml and 1.56 Đg/ml in period III (October 1990 November 1991, MSSA 39 strains and MRSA 40 strains). The two strains of S. aureus highly resistant to vancomycin (VCM, MIC > 100 Đg/ml) were observed in the urine of a patient with complicated urinary tract infection and iter of a patient with bed sore infection in period II, but were sensitive to TEIC (0. 2 Đg/ml and 0.39 Đg/ml). The in vitro activity of TEIC against those bacteria was superior to that of VCM. The serum level of TEIC was studied in an 82 year-old womam with pyothorax caused by MRSA. The maximum serum level was 60.4 Đg/ml after intravenous administration of 200 mg/ml. At three hours after intravenous administration, 18.3 jig/ml of TEIC was detected. Four patient with sepsis caused by Enterococcus faecium, sepsis caused by S. aureus and Clostridium spp., pyothorax caused by MRSA and carbuncle caused by MRSA were studied for the clinical evaluation of TEIC. TEIC was given intravenously at 200-400 mg per day for 5 `14 days. The rate of clinical efficacy was 100%, and all the causative organisms were eliminated. No adverse effect was observed. We concluded that TEIC is a very useful intravenous antimicrobial agent for the treatment of gram-positive infections, including MRSA infections.

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