Teicoplanin versus flucloxacillin in the treatment of infection following burns

Abstract

Antibiotic treatment of patients developing infection after burns is principally based on experience with other surgical patients. Few comparative trials have been performed in burns patients despite the altered pharmacokinetics of antibiotics and the high incidence of Gram-positive infection in the first week. A randomized trial was performed to compare the cure rates of presumed Gram-positive infection in burns patients given teicoplanin (6 mg/kg every 12 h for three doses then daily) or flucloxacillin (1 g every 6 h i.v./p.o.). Both groups received gentamicin if additional Gram-negative infection was thought likely. A total of 64 patients were entered into the study representing 65 episodes of treatment of which 55 were completed. Clinical success was achieved in 22 (73%) of 30 evaluable patients given teicoplanin and in 21 (68%) of 31 evaluable patients given flucloxacillin (not significant). Of 51 patients assessable for bacteriological efficacy, clearance was achieved in 15 (63%) of 24 patients given teicoplanin and in 15 (56%) of 27 patients given flucloxacillin (not significant). Serum trough concentrations of teicoplanin were 9 mg/L in five patients at the steady state. Adverse events were recorded in 15 (48%) of episodes in the teicoplanin group and in 14 (41%) of episodes in the flucloxacillin group. Teicoplanin demonstrated similar efficacy and safety to flucloxacillin with or without gentamicin.