There is a scenario I come across on a fairly regular basis which drives me NUTS! It is the use of Teicoplanin to treat urinary tract infections especially pyelonephritis. It drives me nuts because Teicoplanin has no activity against Gram-negative bacteria and pyelonephritis is 99% of the time caused by these Gram-negative bacteria. Therefore the patient is essentially on no treatment at all. Pyelonephritis is the most common cause of Gram-negative sepsis and if not
treated with the appropriate antibiotics, sepsis has a mortality of 40% (see sepsis).
treated with the appropriate antibiotics, sepsis has a mortality of 40% (see sepsis).
So why is Teicoplanin used to treat UTIs? To be honest I have no idea, it’s a total mystery to me. I have never been able to find a reason, however I see it too frequently for it to be by chance.
Whatever the reason for using Teicoplanin, it is certainly the wrong antibiotic where Gram-negative bacteria are the most likely causes. The most commonly isolated Gram-negative bacteria from urine are the Enterobacteriaceae (e.g. E. coli, Klebsiella sp., Proteus sp.) and Pseudomonas sp.
Clinical scenarios where Teicoplanin IS appropriate as a second line antibiotic are usually caused by Staphylococci or
Streptococci :
• Cellulitis
• Osteomyelitis
• Septic arthritis (especially prosthetic joint)
• Infective endocarditis
• Severe community acquired pneumonia (in combination with a quinolone)
Clinical scenarios where Teicoplanin IS NOT appropriate are usually caused by either Gram-negative bacteria alone or mixtures where Gram-negative bacteria are the main pathogens:
• Urinary tract infection
• Peritonitis
• Cholecystitis and cholangitis
• Sepsis
Remember, Teicoplanin is only active against Gram-positive bacteria such as Staphylococcus, Streptococcus, Listeria and Enterococcus. Teicoplanin has no Gram-negative activity. It therefore should NEVER be used to treat infections caused by Gram-negative bacteria; it will just give all of the side effects (neutropaenia, thrombocytopaenia and renal failure) with none of the benefits.
To remember this try the mnemonic “Teicoplanin is active against LESS” - Listeria, Enterococcus, Staphylococcus and Streptococcus
PS If you know why Teicoplanin is wrongly used to treat UTIs, do let me know.
Whatever the reason for using Teicoplanin, it is certainly the wrong antibiotic where Gram-negative bacteria are the most likely causes. The most commonly isolated Gram-negative bacteria from urine are the Enterobacteriaceae (e.g. E. coli, Klebsiella sp., Proteus sp.) and Pseudomonas sp.
Clinical scenarios where Teicoplanin IS appropriate as a second line antibiotic are usually caused by Staphylococci or
Streptococci :
• Cellulitis
• Osteomyelitis
• Septic arthritis (especially prosthetic joint)
• Infective endocarditis
• Severe community acquired pneumonia (in combination with a quinolone)
Clinical scenarios where Teicoplanin IS NOT appropriate are usually caused by either Gram-negative bacteria alone or mixtures where Gram-negative bacteria are the main pathogens:
• Urinary tract infection
• Peritonitis
• Cholecystitis and cholangitis
• Sepsis
Remember, Teicoplanin is only active against Gram-positive bacteria such as Staphylococcus, Streptococcus, Listeria and Enterococcus. Teicoplanin has no Gram-negative activity. It therefore should NEVER be used to treat infections caused by Gram-negative bacteria; it will just give all of the side effects (neutropaenia, thrombocytopaenia and renal failure) with none of the benefits.
To remember this try the mnemonic “Teicoplanin is active against LESS” - Listeria, Enterococcus, Staphylococcus and Streptococcus
PS If you know why Teicoplanin is wrongly used to treat UTIs, do let me know.
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