Diogo Diniz Gomes Bugano1, Alexandre Biasi Cavalcanti2, Anderson Roman Goncalves3, Claudia Salvini de Almeida4, Eliézer Silva5. 1. Hospital das Clínicas, Universidade de São Paulo - USP, São Paulo, SP, BR. 2. Education and Research Institute, Hospital do Coração - HCor, São Paulo, SP, BR. 3. Medical department, Universidade da Região de Joinville - UNIVILLE, Joinville, SC, BR. 4. Department of Pediatrics, Hospital das Clinicas, Universidade de São Paulo - USP, São Paulo, SP, BR. 5. Intensive Care Unit, Hospital Israelita Albert Einstein - HIAE, São Paulo, SP, BR.
Abstract
OBJECTIVE: To compare efficacy and safety of vancomycin versusteicoplanin in patients with proven or suspected infection. DATA SOURCES: Cochrane Renal Group's Specialized Register, CENTRAL, MEDLINE, EMBASE, nephrology textbooks and review articles. INCLUSION CRITERIA: Randomized controlled trials in any language comparing teicoplanin to vancomycin for patients with proven or suspected infection. DATA EXTRACTION: Two authors independently evaluated methodological quality and extracted data. Study investigators were contacted for unpublished information. A random effect model was used to estimate the pooled risk ratio (RR) with 95% confidence interval (CI). RESULTS: A total of 24 studies (2,610 patients) were included. The drugs had similar rates of clinical cure (RR: 1.03; 95%CI: 0.98-1.08), microbiological cure (RR: 0.98; 95%CI: 0.93-1.03) and mortality (RR: 1.02; 95%CI: 0.79-1.30). Teicoplanin had lower rates of skin rash (RR: 0.57; 95%CI: 0.35-0.92), red man syndrome (RR: 0.21; 95%CI: 0.08-0.59) and total adverse events (RR: 0.73; 95%CI: 0.53-1.00). Teicoplanin reduced the risk of nephrotoxicity (RR: 0.66; 95%CI: 0.48-0.90). This effect was consistent for patients receiving aminoglycosides (RR: 0.51; 95%CI: 0.30-0.88) or having vancomycin doses corrected by serum levels (RR: 0.22; 95%CI: 0.10-0.52). There were no cases of acute kidney injury needing dialysis. LIMITATIONS: Studies lacked a standardized definition for nephrotoxicity. CONCLUSIONS: Teicoplanin and vancomycin are equally effective; however the incidence of nephrotoxicity and other adverse events was lower with teicoplanin. It may be reasonable to consider teicoplanin for patients at higher risk for acute kidney injury.
OBJECTIVE: To compare efficacy and safety of vancomycin versusteicoplanin in patients with proven or suspected infection. DATA SOURCES: Cochrane Renal Group's Specialized Register, CENTRAL, MEDLINE, EMBASE, nephrology textbooks and review articles. INCLUSION CRITERIA: Randomized controlled trials in any language comparing teicoplanin to vancomycin for patients with proven or suspected infection. DATA EXTRACTION: Two authors independently evaluated methodological quality and extracted data. Study investigators were contacted for unpublished information. A random effect model was used to estimate the pooled risk ratio (RR) with 95% confidence interval (CI). RESULTS: A total of 24 studies (2,610 patients) were included. The drugs had similar rates of clinical cure (RR: 1.03; 95%CI: 0.98-1.08), microbiological cure (RR: 0.98; 95%CI: 0.93-1.03) and mortality (RR: 1.02; 95%CI: 0.79-1.30). Teicoplanin had lower rates of skin rash (RR: 0.57; 95%CI: 0.35-0.92), red man syndrome (RR: 0.21; 95%CI: 0.08-0.59) and total adverse events (RR: 0.73; 95%CI: 0.53-1.00). Teicoplanin reduced the risk of nephrotoxicity (RR: 0.66; 95%CI: 0.48-0.90). This effect was consistent for patients receiving aminoglycosides (RR: 0.51; 95%CI: 0.30-0.88) or having vancomycin doses corrected by serum levels (RR: 0.22; 95%CI: 0.10-0.52). There were no cases of acute kidney injury needing dialysis. LIMITATIONS: Studies lacked a standardized definition for nephrotoxicity. CONCLUSIONS:Teicoplanin and vancomycin are equally effective; however the incidence of nephrotoxicity and other adverse events was lower with teicoplanin. It may be reasonable to consider teicoplanin for patients at higher risk for acute kidney injury.
Authors: A Kontou; K Sarafidis; O Begou; H G Gika; A Tsiligiannis; K Ogungbenro; A Dokoumetzidis; E Agakidou; E Roilides Journal: Antimicrob Agents Chemother Date: 2020-03-24 Impact factor: 5.191
Authors: J D Workum; C Kramers; E Kolwijck; J A Schouten; S N de Wildt; R J Brüggemann Journal: J Antimicrob Chemother Date: 2021-01-01 Impact factor: 5.790