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Abstract
Background: Vancomycin has reliable antibacterial activity against many gram-positive pathogens
but is associated with many adverse events. Teicoplanin, another glycopeptide, is
associated with fewer adverse events, but its use in patients with previous vancomycininduced
adverse reactions remains controversial.
Objectives: The aims of this work were to evaluate the clinical characteristics of hospitalized
patients with vancomycin-induced fever (ie, drug fever), rash, or neutropenia and
to examine the tolerability of teicoplanin in these patients.
Methods: This was a retrospective review of the medical charts of patients aged ≥18 years
who were hospitalized between January 2002 and October 2007 at National Cheng Kung
University Hospital in Tainan, Taiwan. Patients were included if they experienced
drug-induced fever (ie, “drug fever”), rash, or neutropenia during vancomycin treatment.
Their antimicrobial therapy was subsequently switched to teicoplanin. Clinical information
and the development of drug fever, rash, or neutropenia with teicoplanin were determined
from the charts.
Results: Antibiotic therapy was switched to teicoplanin in 117 patients with vancomycin-induced
fever alone (n = 24), rash alone (n = 77), both drug fever and rash (n = 8), or neutropenia
(n = 8). The mean (SD) age of these patients was 53.1 (22.8) years, and 65 (56%) were
male. The major clinical indications for vancomycin therapy among these patients were
wound infections (21%), respiratory tract infections (14%), and bacteremia (13%).
The dosages for vancomycin ranged from 1 g every 5 days to 1 g BID, and for teicoplanin
ranged from 400 mg daily to 400 mg q72h, adjusted by the degree of renal dysfunction.
Overall, 12 patients with vancomycin-induced fever (n = 2), rash (n = 6), or neutropenia
(n = 4) subsequently developed teicoplanin-induced fever (n = 3), rash (n = 3), or
neutropenia (n = 6). Specifically, of 8 patients with vancomycin-induced neutropenia,
4 (50%) subsequently developed neutropenia after switching to teicoplanin. Vancomycin-
and teicoplanininduced neutropenia was often noted after 1 week of treatment. Among
patients with vancomycin-induced fever, rash, or neutropenia, there were no differences
between patients with or without teicoplanin-induced fever, rash, or neutropenia in
terms of age, sex, weight, dosage or duration of vancomycin therapy, dosage of teicoplanin,
or underlying disease. There was no difference in mortality rates between patients
with or without teicoplanin-induced fever, rash, or neutropenia. The cause of all
deaths was progression of infectious or underlying disease, unrelated to vancomycin
or teicoplanin use.
Conclusions: Based on this retrospective chart review of hospitalized patients with vancomycin-induced
fever, rash, or neutropenia, only 10% experienced subsequent teicoplanin-induced fever,
rash, or neutropenia. However, it should be noted that half of the patients with vancomycin-induced
neutropenia developed teicoplanin-induced neutropenia.
Key words
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Article info
Publication history
Accepted:
July 8,
2009
Identification
Copyright
© 2009 Excerpta Medica Inc. All rights reserved. Published by Elsevier Inc.
