Teicoplanin versus Vancomycin for Severe Gram-positive Bacterial Infection: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 BAODeng ¹ , LIYa ² , CHANGXiao-hong ¹

1. Department of Respiratory Medicine, Affiliated Hospital of Yan'an University, Yan'an 716000, China;
2. Department of Endocrinology, Affiliated Hospital of Yan'an University, Yan'an 716000, China;

Corresponding?author：

Keywords：

Vancomycin; Teicoplanin; Multiple drug resistance; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20140140

Video：

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Objective To systematically review the therapeutic effects and safety of teicoplanin versus vancomycin for severe gram-positive bacterial infection. Methods We electronically searched CBM, CNKI, VIP, WanFang Data, PubMed, EMbase, The Cochrane Library (Issue 3, 2013) and Springer for the internationally-nationally published randomized controlled trials (RCTs) on teicoplanin versus vancomycin for severe gram-positive bacterial infections from inception to October 2013. Two reviewers screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then meta-analysis was performed using RevMan 5.2 software. Results Twenty RCTs were finally included, involving 1 555 patients with severe gram-positive bacterial infection. The results of meta-analysis showed that there was no significant difference between teicoplanin and vancomycin with regard to all-cause mortality (OR=1.67, 95%CI 0.86 to 3.23, P=0.13), clinical cure rates (OR=1.24, 95%CI 0.95 to 1.60, P=0.11), effective rates (OR=1.03, 95%CI 0.75 to 1.41, P=0.87), and bacterial clearance rates (OR=0.96, 95%CI 0.66 to 1.39, P=0.83). However, the incidence of adverse reaction was lower in the teicoplanin group than in the vancomycin with a significant difference (OR=0.50, 95%CI 0.34 to 0.72, P=0.000 2). Conclusion The results of meta-analysis shows that, teicoplanin is similar to vancomycin in therapeutic effects on treating severe gram-positive bacterial infection but it is better in safety. However, because of limited quantity and quality of the included studies, the above conclusion needs to be further verified by conducting more high-quality studies.

Citation： BAODeng, LIYa, CHANGXiao-hong. Teicoplanin versus Vancomycin for Severe Gram-positive Bacterial Infection: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2014, 14(7): 841-848. doi: 10.7507/1672-2531.20140140 Copy

1.	陳潔, 李巖, 王晶, 等.耐甲氧西林金黃色葡萄球菌SCCmec基因分型及耐藥譜分析.中華醫院感染學雜志, 2012, 22(5):894-897.
2.	王爽, 宋志香.耐甲氧西林金黃色葡萄球菌感染的臨床特征、耐藥性及治療研究進展.實用醫院臨床雜志, 2009, 6(4):137-139.
3.	Gould IM. Clinical activity of anti-Gram-positive agents against methicillin-resistant staphyl-lococcus aereus. Antimicrob Agents Chemother, 2011, 66:17-21.
4.	Wood MJ. The comparative efficacy and safety of teicoplanin and vancomycin. Antimicrob Agents Chemother, 1996, 37:209-222.
5.	中華醫學會, 中華醫院管理學會藥事管理專業委員會, 中國藥學會醫院藥學專業委員會.抗菌藥物臨床應用指導原則.中華醫學雜志, 2004, 84(23):1857-1862.
6.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.cochrane-handbook.org.
7.	Auwera P, Aoun M, Meunier F. Randomized study of vancomycin versus teicoplanin for the treatment of gram-positive bacterial infections in immunocompromised hosts. Antimicrob Agents Chemother, 1991, 35:451-457.
8.	Smith SR, Cheesbrough J, Spearing R, et al. Randomized prospective study comparing vancomycin with teicoplanin in the treatment of infections associated with hickman catheters. Antimicrob Agents Chemother, 1989, 33:1193-1197.
9.	Liu CY, Lee WS, Fung CP, et al. Comparative study of teicoplanin vs vancomycin for the treatment of methicillin-resistant Staphylococcus aureus bacteraemia. Clin Drug Investig, 1996, 12:80-87.
10.	Kureishi A, Jewesson PJ, Rubinger M, et al. Double-blind comparison of teicoplanin versus vancomycin in febrile neutropenic patients receiving concomitant tobramycin and piperacillin:effect on cyclosporin associated nephrotoxicity. Antimicrob Agents Chemother, 1991, 35:2246-2252.
11.	Nucci M, Biasoli I, Braggio S, et al. Ceftazidime plus amikacin plusteicoplanin or vancomycin in the empirical antibiotic therapy in febrile neutropenic cancer patients. Oncol Rep, 1998, 5:1205-1209.
12.	Figuera A, Tomas JF, Hernandez L, et al. Fernandez-Ranada Imipenem combined with teicoplanin or vancomycin in the initial empirical treatment of febrile neutropenia. Analysis of the primary response and of a global sequential strategy in 126 episodes. Rev Clin Esp, 1996, 196:515-522.
13.	Gilbert DN, Wood CA, Kimbrough RC, et al. Failure of treatment with teicoplanin at 6 Milligrams/kilogram/day in patients with Staphylococcus aureus intravascular infection. Anti-microb Agents Chemother, 1991, 35:79-87.
14.	Vazquez L, Encinas MP, Morin LS, et al. Randomized prospective study comparing cost-effectiveness of teicoplanin and vancomycin as second-line empiric therapy for infection in neutropenic patients. Haematologica, 1999, 84:231-236.
15.	唐詠梅.替考拉寧與萬古霉素對革蘭陽性菌感染的療效及安全性分析.中國藥業, 2013, 22(15):15-16.
16.	呂芳芳, 周志慧, 俞云松, 等.替考拉寧與萬古霉素隨機對照多中心臨床研究.中國臨床藥理學雜志, 2002, 78(4):343-246.
17.	董裸, 陳小東.替考拉寧與萬古霉素治療MASA下呼吸道感染的療效與安全性評價.中華醫院感染學雜志, 2010, 20(5):711-712.
18.	彭浩, 賀全勇, 羅成群, 等.替考拉寧與萬古霉素治療重度燒傷合并MASA感染的臨床觀察.中華醫院感染學雜志, 2010, 20(11):1594-1595.
19.	祖育娜, 許愛國.替考拉寧與萬古霉素治療重癥革蘭陽性菌感染的療效和安全性.中華醫院感染學雜志, 2010, 20(4):552-554.
20.	馮靖雄.替考拉寧與萬古霉素隨機對照治療重癥G+球菌感染的療效和安全性.北方藥學, 2012, 9(8):73-74.
21.	趙衛峰, 凌春華, 張險峰, 等.替考拉寧與萬古霉素隨機對照治療重癥G+球菌感染的臨床研究.江蘇醫藥, 2003, 29(12):913-915.
22.	張天托, 黃樹燦, 周鳳麗, 等.替考拉寧治療G+菌感染的療效和安全性.中國新藥雜志, 2003, 12(12):1041-1043.
23.	孫曉霞, 方巍, 孫運波.萬古霉素和替考拉寧治療ICU耐甲氧西林金黃色葡萄球菌感染的評價.齊魯醫學雜志, 2009, 24(6):533-537.
24.	朱惠莉, 龔瑾, 符禮剛, 等.替考拉寧與萬古霉素治療老年人耐甲氧西林金葡菌肺部感染的評價.中國臨床醫學, 2003, 10(2):183-185.
25.	謝續標, 葉明佶, 彭龍開, 等.國產替考拉寧與進口萬古霉素治療腎移植術后革蘭陽性球菌肺部感染的評價.中華醫院感染學雜志, 2010, 20(15):2296-2298.
26.	胡述平, 薛南平, 晏怡.鞘內注射替考拉寧治療革蘭陽性球菌顱內感染.重慶醫學, 2009, 38(19):2486-2487.
27.	楊世杰.藥理學.第2版.北京:人民衛生出版社, 2010:385-386.
28.	Kullar R, Davis SL, Levine DP, et al. Impact of vancomycin exposure on outcomes in patientswith methicillin-resistant Staphylo-coccus aureus bacteremia:support for consensus guidelines suggested targets. Clin Infect Dis, 2011, 52(8):975-981.
29.	張獻全, 張安, 王鵬飛, 等.替考拉寧治療ICU耐甲氧西林金黃色葡萄球菌感染的療效觀察.中華醫院感染學雜志, 2009, 19(22):3099-3101.
30.	Sancar AA, Yegenoglu S, Vries R, et al. Vancomycin vs teicoplanin in the treatment of gram-positive infections:a armacoeconomic analysis in a Turkish Unive rsity Hospitial. Harm World Sci, 2008, 30:916-923.
31.	張之萌.替考拉寧及萬古霉素療效與安全性比較.國外醫藥抗生素分冊, 1997, 18(5):381-389.
32.	富振英. Meta-analysis研究資料的統計分析方法.藥物流行病學雜志, 1994, 3:220-222.

1. 陳潔, 李巖, 王晶, 等.耐甲氧西林金黃色葡萄球菌SCCmec基因分型及耐藥譜分析.中華醫院感染學雜志, 2012, 22(5):894-897.
2. 王爽, 宋志香.耐甲氧西林金黃色葡萄球菌感染的臨床特征、耐藥性及治療研究進展.實用醫院臨床雜志, 2009, 6(4):137-139.
3. Gould IM. Clinical activity of anti-Gram-positive agents against methicillin-resistant staphyl-lococcus aereus. Antimicrob Agents Chemother, 2011, 66:17-21.
4. Wood MJ. The comparative efficacy and safety of teicoplanin and vancomycin. Antimicrob Agents Chemother, 1996, 37:209-222.
5. 中華醫學會, 中華醫院管理學會藥事管理專業委員會, 中國藥學會醫院藥學專業委員會.抗菌藥物臨床應用指導原則.中華醫學雜志, 2004, 84(23):1857-1862.
6. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.cochrane-handbook.org.
7. Auwera P, Aoun M, Meunier F. Randomized study of vancomycin versus teicoplanin for the treatment of gram-positive bacterial infections in immunocompromised hosts. Antimicrob Agents Chemother, 1991, 35:451-457.
8. Smith SR, Cheesbrough J, Spearing R, et al. Randomized prospective study comparing vancomycin with teicoplanin in the treatment of infections associated with hickman catheters. Antimicrob Agents Chemother, 1989, 33:1193-1197.
9. Liu CY, Lee WS, Fung CP, et al. Comparative study of teicoplanin vs vancomycin for the treatment of methicillin-resistant Staphylococcus aureus bacteraemia. Clin Drug Investig, 1996, 12:80-87.
10. Kureishi A, Jewesson PJ, Rubinger M, et al. Double-blind comparison of teicoplanin versus vancomycin in febrile neutropenic patients receiving concomitant tobramycin and piperacillin:effect on cyclosporin associated nephrotoxicity. Antimicrob Agents Chemother, 1991, 35:2246-2252.
11. Nucci M, Biasoli I, Braggio S, et al. Ceftazidime plus amikacin plusteicoplanin or vancomycin in the empirical antibiotic therapy in febrile neutropenic cancer patients. Oncol Rep, 1998, 5:1205-1209.
12. Figuera A, Tomas JF, Hernandez L, et al. Fernandez-Ranada Imipenem combined with teicoplanin or vancomycin in the initial empirical treatment of febrile neutropenia. Analysis of the primary response and of a global sequential strategy in 126 episodes. Rev Clin Esp, 1996, 196:515-522.
13. Gilbert DN, Wood CA, Kimbrough RC, et al. Failure of treatment with teicoplanin at 6 Milligrams/kilogram/day in patients with Staphylococcus aureus intravascular infection. Anti-microb Agents Chemother, 1991, 35:79-87.
14. Vazquez L, Encinas MP, Morin LS, et al. Randomized prospective study comparing cost-effectiveness of teicoplanin and vancomycin as second-line empiric therapy for infection in neutropenic patients. Haematologica, 1999, 84:231-236.
15. 唐詠梅.替考拉寧與萬古霉素對革蘭陽性菌感染的療效及安全性分析.中國藥業, 2013, 22(15):15-16.
16. 呂芳芳, 周志慧, 俞云松, 等.替考拉寧與萬古霉素隨機對照多中心臨床研究.中國臨床藥理學雜志, 2002, 78(4):343-246.
17. 董裸, 陳小東.替考拉寧與萬古霉素治療MASA下呼吸道感染的療效與安全性評價.中華醫院感染學雜志, 2010, 20(5):711-712.
18. 彭浩, 賀全勇, 羅成群, 等.替考拉寧與萬古霉素治療重度燒傷合并MASA感染的臨床觀察.中華醫院感染學雜志, 2010, 20(11):1594-1595.
19. 祖育娜, 許愛國.替考拉寧與萬古霉素治療重癥革蘭陽性菌感染的療效和安全性.中華醫院感染學雜志, 2010, 20(4):552-554.
20. 馮靖雄.替考拉寧與萬古霉素隨機對照治療重癥G+球菌感染的療效和安全性.北方藥學, 2012, 9(8):73-74.
21. 趙衛峰, 凌春華, 張險峰, 等.替考拉寧與萬古霉素隨機對照治療重癥G+球菌感染的臨床研究.江蘇醫藥, 2003, 29(12):913-915.
22. 張天托, 黃樹燦, 周鳳麗, 等.替考拉寧治療G+菌感染的療效和安全性.中國新藥雜志, 2003, 12(12):1041-1043.
23. 孫曉霞, 方巍, 孫運波.萬古霉素和替考拉寧治療ICU耐甲氧西林金黃色葡萄球菌感染的評價.齊魯醫學雜志, 2009, 24(6):533-537.
24. 朱惠莉, 龔瑾, 符禮剛, 等.替考拉寧與萬古霉素治療老年人耐甲氧西林金葡菌肺部感染的評價.中國臨床醫學, 2003, 10(2):183-185.
25. 謝續標, 葉明佶, 彭龍開, 等.國產替考拉寧與進口萬古霉素治療腎移植術后革蘭陽性球菌肺部感染的評價.中華醫院感染學雜志, 2010, 20(15):2296-2298.
26. 胡述平, 薛南平, 晏怡.鞘內注射替考拉寧治療革蘭陽性球菌顱內感染.重慶醫學, 2009, 38(19):2486-2487.
27. 楊世杰.藥理學.第2版.北京:人民衛生出版社, 2010:385-386.
28. Kullar R, Davis SL, Levine DP, et al. Impact of vancomycin exposure on outcomes in patientswith methicillin-resistant Staphylo-coccus aureus bacteremia:support for consensus guidelines suggested targets. Clin Infect Dis, 2011, 52(8):975-981.
29. 張獻全, 張安, 王鵬飛, 等.替考拉寧治療ICU耐甲氧西林金黃色葡萄球菌感染的療效觀察.中華醫院感染學雜志, 2009, 19(22):3099-3101.
30. Sancar AA, Yegenoglu S, Vries R, et al. Vancomycin vs teicoplanin in the treatment of gram-positive infections:a armacoeconomic analysis in a Turkish Unive rsity Hospitial. Harm World Sci, 2008, 30:916-923.
31. 張之萌.替考拉寧及萬古霉素療效與安全性比較.國外醫藥抗生素分冊, 1997, 18(5):381-389.
32. 富振英. Meta-analysis研究資料的統計分析方法.藥物流行病學雜志, 1994, 3:220-222.

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Teicoplanin versus Vancomycin for Severe Gram-positive Bacterial Infection: A Systematic Review

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