Some of the views expressed in the following notes on newly approved products should be regarded as preliminary, as there may have been limited published data at the time of publication, and little experience in Australia of their safety or efficacy. However, the Editorial Executive Committee believes that comments made in good faith at an early stage may still be of value. Before new drugs are prescribed, the Committee believes it is important that more detailed information is obtained from the manufacturer's approved product information, a drug information centre or some other appropriate source.
Targocid (Marion Merrell Dow Australia)
20 mg/mL as lyophilised powder in 20 mL vials
Indication: specified infections
Teicoplanin is a glycopeptide antibiotic with similarities to vancomycin. The drug acts by inhibiting cell wall synthesis in dividing organisms. As this mechanism is different to the action of beta-lactam antibiotics, teicoplanin has no cross resistance with these drugs. Only Gram positive organisms are susceptible; all Gram negative organisms are resistant.
The drug should be reconstituted with water precisely in accordance with the manufacturer's directions. After teicoplanin is given intravenously, there is a biphasic distribution, followed by a prolonged elimination period. The elimination half life is 70-100 hours with most of the dose being excreted unchanged in the urine. Twice daily dosing is advised with reduced doses for patients with renal impairment.
Teicoplanin has been approved for the treatment of serious staphylococcal or streptococcal infections which cannot be treated satisfactorily with less toxic antibiotics. Therefore, teicoplanin can be used in cases of osteomyelitis, septic arthritis and septicaemia. Endocarditis is not an approved indication. Practitioners should be aware that teicoplanin may be less active than vancomycin against some staphylococci e.g. Staphylococcus haemolyticus.
Common adverse effects include rashes, fever, pruritus, diarrhoea, nausea and vomiting. Ototoxicity has been reported so auditory function should be monitored if other neurotoxic drugs, e.g. aminoglycosides, are being given or treatment is prolonged in a patient with renal insufficiency. Other adverse effects include altered liver function, leucopenia, thrombocytopenia, hypersensitivity and impaired renal function.
Although teicoplanin may have fewer adverse effects, this advantage is said to be insufficient to recommend that it is used instead of vancomycin.1
- Phillips G, Golledge CL. Vancomycin and teicoplanin: something old, something new. Med J Aust 1992;156:53-7.