Teicoplanin

Teicoplanin belongs to the glycopeptide family, antibiotics reserved for serious infections. To protect itself, a bacterium surrounds itself with a rigid wall, the peptidoglycan, which it assembles continuously. Teicoplanin binds to the D-alanyl-D-alanine residues of the precursors of this wall and prevents their assembly. Deprived of a solid wall, the bacterium can no longer divide or resist, and it dies.

This attachment point differs from that of the beta-lactams, which include the penicillins. Teicoplanin therefore acts through a different route, which makes it useful when those antibiotics are no longer enough. Its action targets Gram-positive bacteria specifically, those whose thick wall is the target of this mechanism.

Teicoplanin treats serious infections caused by Gram-positive bacteria. By the injectable route, it covers infections of the bones and joints, endocarditis (infection of the heart valves), pneumonia, and infections of the skin and soft tissues. These are serious situations, often managed in hospital.

By the oral route, its use is limited to a single indication: Clostridium difficile colitis, an infection of the colon. The choice of route therefore depends on the infection targeted. This split explains why the same molecule is given sometimes in an infusion, sometimes by mouth.

For an infection in the blood or the organs, teicoplanin is given by the intravenous or intramuscular route, never by mouth. Taken orally, it is not absorbed by the digestive tract and does not pass into the blood. A healthcare professional carries out the injection or infusion. The question of when to take it in relation to meals therefore does not arise for the injectable form.

Its elimination half-life is very long, from 100 to 170 hours: the medicine stays active for several days in the body. Repeated loading doses are given first to reach an effective concentration quickly, then a single maintenance dose per day. The regularity of this schedule determines the effectiveness of the treatment. It is never stopped on one’s own initiative, even if the infection appears to be clearing.

Some effects affect at least one person in a hundred. These include a drop in platelets (thrombocytopenia), a rise in one type of white blood cell (eosinophilia), and an increase in liver transaminases, often transient. On the digestive side, diarrhoea, nausea and vomiting are possible. To these are added skin rash, dizziness, headache, pain, fever, and inflammation of the vein at the injection site (phlebitis).

Other effects are uncommon, that is, present in fewer than one person in a hundred. These are acute kidney failure, seizures, and damage to hearing and balance (ototoxicity). These signs justify medical monitoring during treatment.

More rarely, in fewer than one person in a thousand, there may occur a rise in blood creatinine, a bronchospasm, an anaphylactic reaction, or red man syndrome. The latter combines itching, hives, redness, angioedema, a faster heartbeat, a drop in blood pressure and breathing difficulty. These reactions call for immediate management.

Even more rarely, serious skin reactions have been described: DRESS syndrome, Stevens-Johnson syndrome and toxic epidermal necrolysis. They affect the skin and the general condition. Any widespread skin change during treatment should raise the alarm and lead to seeking care without delay.

Teicoplanin is used with caution when it is combined with medicines toxic to the kidney or to the ear: aminoglycosides, amphotericin B, ciclosporin, cisplatin, colistin, furosemide, etacrynic acid. The accumulation of these toxicities increases the risk of kidney or hearing damage. It must never be mixed in the same solution as an aminoglycoside.

Biological monitoring frames the treatment. It includes measuring trough concentrations in the blood once steady state is reached, a regular full blood count, and monitoring of kidney and liver function. In the case of co-treatment toxic to the ear, a hearing check is added to this follow-up.