TEICOPLANIN IN THE THERAPY OF BONE AND JOINT INFECTIONS

Bone and joint infections often present special therapeutic problems, and the optimal antibiotic treatment has not been definitely established. Teicoplanin, a new glycopeptide antibiotic with bactericidal activity against gram-positive bacteria, penetrates tissues easily and reaches high concentrations in bone and cartilage. We evaluated teicoplanin in a prospective, open, multicenter study in order to gain experience in the clinical use of teicoplanin in the field of bone and joint infections. Seventy-five patients (24 women, 51 men; mean age, 55 +/- 19 years) with bone and joint infections entered the study. Forty-six patients had osteomyelitis, 29 other bone and joint infections. Pre-disposing or complicating factors such as surgery, trauma, or diabetes were present in 69% of the cases. Twenty-eight percent of the patients had undergone previous antibiotic therapy. In 73.1% previous treatment was discontinued due to therapy failure. Mean duration of teicoplanin therapy was 13.6 +/- 6.5 days. Initially, teicoplanin was administered intravenously in all but one patient; subsequently, 31.1% received a combination of both intramuscular and intravenous therapy while that of the patient with intramuscular application route remained unchanged. Initial dosage was 400 mg for 81.9% of the patients and 800 mg for 11.1% of the patients; 6.9% received other initial doses (minimum, 200 mg). Mean consecutive dosage was 266.2 +/- 93.5 mg (range, 80 to 400 mg) depending on the severity of the underlying disease. Concomitant antibiotic treatment was given in 25.3% of the cases. Overall clinical success rate was 88%. Of 75 patients, 54.7% were clinically cured and 33.3% improved significantly. Therapy failure was observed in 8%. Isolated pathogens were Staphylococcus aureus (71.1%), coagulase-negative staphylococci (14.5%), and streptococci (14.5%). Using agar dilution and agar diffusion methods, teicoplanin was found to be highly active against the isolated pathogens. Elimination of the pathogen was observed in 51.3% of cases, and persistence or recurrence occurred in 2.6% and 3.9%, respectively; 42.1% of the cases were judged to be not evaluable since follow-up cultures could not be obtained, mainly because the patients were clinically cured. In general, teicoplanin therapy was well tolerated. Adverse events were seen in six patients (three allergic reactions, one liver enzyme increase, one local reaction at the infection site, and one case of nausea). All of these were regarded as mild or moderate. Additional surgical intervention was undertaken in 86.7% of the patients. After the end of treatment an additional follow-up period (mean duration, 9.8 months) was assessed. Data for 60 patients were available: 45 patients remained without any relapse, 15 patients showed a relapse within the follow-up period. We conclude that teicoplanin is safe and effective in the treatment of bone and joint infections caused by susceptible pathogens, in combination with other therapeutic measures.