Teicoplanin and vancomycin: clinical indications and usefullness of drug monitoring


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Teicoplanin and vancomycin: clinical indications and usefullness of drug monitoring

Teicoplanine et vancomycin… what are we going to tell you ?

Mode of action : inhibition of bacterial cell wall synthesis upstream to ? lactams

Binding of vancomycin to D-Ala-D-Ala

Relationship between the use of vancomycin and the development of resistance in enteroccci in U.S.A.

Resistance to glycopeptides in Europe ...

Why different levels in North America and Europe ?

Resistance to vancomycin in enterococci (VRE) and staphylocci (GISA): the real issues...

Glycopeptides appropriate uses

Vancomycin in S. Aureus endocarditis (Levine, Ann Intern Med 1991)

Meta-analysis of combined results (Wood, JAC 1996)

Reported nephrotoxicity (Wood, JAC 1996)

Comparative efficacy and safety of teicoplanin and vancomycin Wood, JAC 1996)

Glycopeptides inappropriate uses (1/2)

Glycopeptides inappropriate uses (2/2)

Can pharmacokinetics/pharmacodynamics help in optimizing glycopeptide treatments ?

Glycopeptides PK/PD: which is the important parameter ?

Area under the curve (AUC)

AUC / MIC ratio

AUC vs peak and trough

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Glycopeptides dosing recommendations at the Cliniques Saint-Luc

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Total cumulative doses of vancomycin based either on the initial dose regimen extrapolated to the duration of treatment (median 21d) or on the dose adjusted by TDM-PK (Clin. Univ. St Luc)

Monitoring and prevention of toxicity: effect of age on vancomycin nephrotoxicity risk (1/2)

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Vancomycin Outcomes vs MIC and AUC/MICs

Vancomycin 1g every 12h (normal adult) PK/PD parameters for 1g every 12h

24h-AUC/MIC and Resistance

Vancomycin “time to eradication” in MRSA Infections

Why is vancomycin so weak vs MRSA?

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Vancomycin /Teicoplanin PK/PD parameters taking into account protein binding

Clinical outcome / teicoplanin predose concentration Mc Gouwan, J Inf Chemother 1996-1998 Harding, JAC 2000 Wilson , IJAA 1994)

Teicoplanin recommanded levels

Conclusions (1/3) ...

Conclusions (2/3) ...

Conclusions (3/3) ...

Thank you ...

But do not forget ...

Author: Paul M. Tulkens

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