Teicoplanin vs vancomycin: cost-effectiveness comparisons.

The rising incidence of methicillin-resistant staphylococci and resistant enterococci in recent years has led to increased use of vancomycin as an active combatant in the treatment of gram-positive infections. Teicoplanin is an investigational glycopeptide that shares a similar spectrum of activity with vancomycin and appears to have similar efficacy. Teicoplanin offers several theoretical advantages compared with vancomycin including once-daily dosing, fewer side effects, and the option for intramuscular administration. While these may be perceived as substantial advances in the glycopeptide class of antibiotics, teicoplanin will probably not replace the now generically available vancomycin on hospital formularies. If competitively priced as a once-daily dosing regimen, teicoplanin will likely gain initial acceptance as an alternative in patients with an intolerance to vancomycin infusion-related side effects or in patients placed on combination aminoglycoside therapy for extended periods of treatment, as an intramuscular antibiotic in patients with poor venous access, and for routine antibiotic prophylaxis where protection from resistant gram-positive pathogens is important. The use of teicoplanin in the hospital may become more widespread as its side effect profile and economic advantages of less frequent dosing compared with vancomycin become better understood.