Abstract
Teicoplanin possesses several convenient properties for use in the delivery of outpatient parenteral antimicrobial therapy (OPAT) services. However, its use is not widespread and data on its efficacy in the OPAT setting are limited. Here we present a case series of patients undergoing OPAT care being treated by either teicoplanin-based (n = 107) or ceftriaxone-based (n = 191) antibiotic regimens. Clinical failure with teicoplanin occurred in five episodes of care (4.7%) compared with only two episodes of ceftriaxone-based OPAT care (1.0%). Teicoplanin-associated clinical failure was observed in 2 (33.3%) of 6 patients with Enterococcus infections compared with 3 (3.0%) of 101 patients with non-Enterococcus infections. Overall, there were four (2.9%) drug-related adverse events for teicoplanin and four (1.8%) for ceftriaxone, prompting a switch to teicoplanin in three patients. These findings support the continued use of teicoplanin in OPAT as well as its consideration in centres where it is not currently being offered.
Highlights
Outpatient parenteral antimicrobial therapy (OPAT) services offer several advantages over conventional inpatient care, including reduced length of inpatient stay, improved patient satisfaction and cost reductions [1,2]
Two commonly used antimicrobial agents in OPAT are ceftriaxone and teicoplanin, with overlapping spectra of activity for Gram-positive infections, ceftriaxone possesses no activity against Enterococcus infections as a single agent [4]
The study was approved by the Audit and Research Committee at the Hospital for Tropical Diseases, University College London Hospitals (UCLH), who stated that as this was a retrospective review of routine clinical data being analysed for service development purposes, further formal ethical approval was not required
Summary
Outpatient parenteral antimicrobial therapy (OPAT) services offer several advantages over conventional inpatient care, including reduced length of inpatient stay, improved patient satisfaction and cost reductions [1,2]. Two commonly used antimicrobial agents in OPAT are ceftriaxone and teicoplanin, with overlapping spectra of activity for Gram-positive infections, ceftriaxone possesses no activity against Enterococcus infections as a single agent [4] The pharmacokinetics of both agents make them an attractive choice for OPAT as they can be administered once daily, and three times weekly for teicoplanin [5] Teicoplanin displays equivalent efficacy with reduced nephrotoxicity compared with the other commonly used glycopeptide, vancomycin [6]. Some groups have reported use of OPAT teicoplanin as an independent risk factor for clinical failure in the management of infective endocarditis [10] and in SSTIs, where 25% of patients experienced treatment failure, and for which ceftriaxone showed superior clinical outcomes [3]. Prospectively collected data were reviewed to assess the clinical outcomes of teicoplanin-based regimens and, where appropriate, to compare with ceftriaxone-based OPAT care
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