Experience with outpatient intravenous teicoplanin therapy for chronic osteomyelitis.

Thirty-seven patients with acute exacerbations of chronic osteomyelitis caused by methicillin-susceptible Staphylococcus aureus (n = 13), methicillin-resistant Staphylococcus aureus (n = 12), methicillin-susceptible coagulase-negative staphylococci (n = 9), methicillin-resistant coagulase-negative staphylococci (n = 1) and enterococci (n = 2) were treated intravenously with teicoplanin. After a loading dose of 7 to 16 mg/kg (median 11 mg/kg) for 4 to 7 days, patients received 9 to 25 mg/kg (median 14 mg/kg) on Mondays, Wednesdays and Fridays in an outpatient setting to reach trough serum levels between 5 mg/l and 15 mg/l. The duration of treatment ranged from 28 to 150 days (median 60 days). Cure was obtained in 14 (38%) and improvement in 17 (46%) cases, and failure was observed in 6 (16%) patients. Adverse effects occurred in 6 patients, and caused discontinuation of treatment in 3 patients. The financial savings exceeded US$60,000 per patient compared with the high hospitalization costs of inpatient treatment.