替考拉宁在耐甲氧西林金黄色葡萄球菌所致感染性心内膜炎的应用评价

Evaluation of teicoplanin against infective endocarditis caused by methicillin-resistant Staphylococcus aureus

目的:评价替考拉宁在耐甲氧西林金黄色葡萄球菌(MRSA)所致感染性心内膜炎的应用。方法:通过比较2014-2015年国内外相关指南、共识及《抗菌药物临床应用指导原则(2015年版)》对MRSA所致感染性心内膜炎的推荐方案,提出有争议的问题:替考拉宁是否适用于治疗MRSA所致感染性心内膜炎?通过查询国内外文献,从循证医学证据、替考拉宁在心脏赘生物的分布、给药方案、治疗药物浓度监测等4个方面进行评价。结果:替考拉宁治疗MRSA所致感染性心内膜炎的循证医学证据还很少,有限的证据表明,替考拉宁常规剂量治疗感染性心内膜炎时,出现更高的失败率。定量放射自显影术显示,替考拉宁只分布在心脏赘生物的外围。替考拉宁用于治疗严重感染时,需要优化给药方案,并进行血药浓度监测。目前替考拉宁的治疗药物浓度监测还未广泛开展,不利于替考拉宁用于严重感染的治疗。结论:不推荐替考拉宁用于治疗MRSA所致的感染性心内膜炎。

OBJECTIVE To evaluate teicoplanin against infective endocarditis caused by （methicillin-resistant Staphylococcus aureus, MRSA）.METHODS A controversial issue ＂whether teicoplanin is applicable in the treatment of infective endocarditis caused by MRSA？＂ was raised by comparing the recommended scheme of infective endocarditis caused by MRSA in the domestic and foreign relevant guidelines, consensus from 2014 to 2015 and Clinical Application of Antimicrobial Agents （2015 version）, to evaluate the evidence based medicine, distribution of teicoplanin in cardiac vegetations, drug regimen and therapeutic drug monitoring （TDM） by querying the domestic and foreign literatures.RESULTS The evidence based medicine of teicoplanin in treatment of infective endocarditis caused by MRSA were rare. Limited evidences suggested that regular doses of teicoplanin in treatment of infective endocarditis showed a higher failure rate. Teicoplanin was concentrated only at the periphery of cardiac neoplasm determined by Quantitative Autoradiography. Optimization of dosing regimen and TDM were needed when teicoplanin was used to treat severe infections. TDM of teicoplanin had not been extensively applied, which was unfavorable for application of teicoplanin to treat serious infections.CONCLUSION Teicoplanin is not recommended in treatment of infective endocarditis caused by MRSA.