Comparative study of teicoplanin vs vancomycin for the treatment of methicillin-resistant Staphylococcus aureus bacteraemia

Forty patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia were randomised to receive either teicoplanin or vancomycin therapy to compare the clinical efficacy and safety of these glycopeptides. Treatment was successful in 17 (85%) of 20 patients who were randomised to the teicoplanin group, with 6 cures and 11 improvements, and in 15 (75%) of 20 patients randomised to the vancomycin group, with 8 cures and 7 improvements (p = 0.69). Microbiologically, all MRSA pathogens isolated were susceptible to both glycopeptides by the disc diffusion test. The mean zone of inhibition for teicoplanin was 18 ± 2mm (range 16 to 20mm) and 20 ± 2 mm (range 16 to 24mm) for vancomycin. The minimum inhibitory concentration required to inhibit the growth of 90% of organisms in culture (MIC₉₀) for all MRSA isolates was 2.0 mg/L (range 0.5 to 4 mg/L) for teicoplanin and 2.0 mg/L (range 0.5 to 2 mg/L) for vancomycin. The microbiological eradication rate was 85% (17 of 20 isolates) for teicoplanin and 75% (15 of 20 isolates) for vancomycin. None of the failures were due to the emergence of resistant pathogens. Adverse reactions occurred in 19% of patients treated with teicoplanin and 60% of patients treated with vancomycin. There was no significant difference in the occurrence of skin rash (p = 0.60) or in elevation of aminotransferase (p = 0.18). However, nephrotoxicity was significantly greater in the vancomycin group than in the teicoplanin group (50 vs 9.5%, p <0.05). In conclusion, the results of this study demonstrate that teicoplanin appears to be a valuable alternative to vancomycin because it is as efficacious as vancomycin, has fewer adverse reactions, and is conveniently administered.