MRSA methicillin-resistant severe sepsis and vancomycin/teicoplanin sensitive.
Right! Therefore, what about the overall cost? And patients with renal failure?
It really depends on the site of the infection and previous microbiological findings. In case of lung origin of infection, we prefer to use teicoplanin because it has better lung penetratiom. Also, if the patient has a MRSA reinfection where vancomycin was the drug od treatment in the first round, we tend to use teicoplanin in the reinfectio treatment. Renal impairment is not the major determining factor- in case of impairment we simply adjust the dosage
In paediatrics we usually use vancomycin for severe infections and teicoplanin for stable patients but it really depends on the clinical setting. As previously mentioned you need to have mind where the infectious focus is. Vancomycin is not as good as its reputation (at least at my institution) but if you want to treat a possible meningitis it has a better penetration pattern than teicoplanin. On the other hand protein binding is an important issue and many kids with severe infectious will have low albumin/protein levels. In Vancomycin you might want to consider continous perfusion as there is some data about improved outcome (CNS shunt infections).
Teicoplanin has an advantage for nursery as it only needs to be given once daily (after 3 loading doses every 12h). No level montoring is needed for teicoplanin and it is usually less aggressive when using peripheral lines.
Another interesting thing to consider for example if you have a pulmonary focus is to use Linezolid.
Thank you Natasa and Peter, probably vancomycin penetrates poorly into the lung and is slowly bactericidial, contrarily the linezolid and teicoplanin pulmonary penetration are good.
Normally vancomycin will be used due to the fact that is less expensive as linezolid.
well for us, we are at the dilemma.. we have MRSA with MIC at 2 by either automated Vitex 2 or E-test... We still use vancomycin due to prohibitive price of linezolid or daptomycin.. to top that none of the alternatives have been proven to be robustly superior to vancomycin when comes to isolates with high MIC..
And I agree that vancomycin has a poor lung penetration and at best should be avoided esp when the MIC is more than 1.. Teicloplanin/ linezolid/ ceftaroline have better PKPD endpoints attainment in pneumonia...
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