Teicoplanin in the treatment of bone and joint infections: An open study.

Osteomyelitis and septic arthritis caused by Gram-positive pathogens may require prolonged inpatient treatment. The glycopeptide antibiotic, teicoplanin, can be administered once daily to outpatients, and was assessed in a multicenter, open trial in patients with such infections. Patients with proven Gram-positive osteomyelitis or septic arthritis were treated with once-daily teicoplanin, 6-12 mg/kg per day, after three loading doses at intervals of 12 h, for 4-6 weeks. A total of 342 patients were recruited, of whom 220 were fully evaluable. Surgical procedures were performed in 82% of patients. Clinical success by the end of treatment was recorded in 81/90 patients (90%) with acute osteomyelitis, 70/79 patients (88.6%) with chronic osteomyelitis, and 42/51 patients (82.4%) with septic arthritis. Four patients with acute and 4 with chronic osteomyelitis and 5 patients with septic arthritis failed to respond to treatment. Relapse was known to have occurred in 10 patients with osteomyelitis and 4 with septic arthritis. Mean trough levels of teicoplanin reached during the first week of therapy were 10 mg/l (mean dose, 6 mg/kg) and 21 mg/l (mean dose, 12 mg/kg). A mean of 75% of the treatment course was given at home. One or more adverse events were reported in 166/342 patients (48.5%), 119 (34.8%) of which were thought to be related to teicoplanin, and treatment was discontinued in 59 patients. Fever, chills, and rashes were the most common side-effects, but were usually mild. Teicoplanin was shown to be a cost-effective method of treatment of bone and joint infections caused by multiple-resistant Gram-positive pathogens.