Activity of teicoplanin and vancomycin against penicillin-resistant pneumococci

  • K. P. Klugman


There are few therapeutic options available for the management of penicillin- and cephalosporin-resistant pneumococcal disease. The glycopeptide agents vancomycin and teicoplanin remain universally active against pneumococci. Against systemic isolates vancomycin demonstrates reliable clinical efficacy, but its use in meningitis is hampered by unreliable CSF penetration. The drug may be used in combination with a third-generation cephalosporin for the treatment of meningitis in settings where resistant strains are common. More data are however required on the interaction of vancomycin and third-generation cephalosporins in the CSF of infected patients. The superior in vitro activity of teicoplanin over vancomycin suggests that further CSF penetration studies are required. Additional studies should also address the interaction of teicoplanin with third generation cephalosporins in vitro and perhaps its use as adjunctive combination therapy for resistant pneumococcal meningitis.


  1. 1.
    Klugman KP Pneumococcal resistance to antibiotics. Clinical Microbiology Reviews 1990, 3: 171–196.PubMedGoogle Scholar
  2. 2.
    Bradley JS, Connor JD Ceftriaxone failure in meningitis caused byStreptococcus pneumoniae with reduced susceptibility to beta-lactam antibiotics. Paediatric Infectious Diseases Journal 1991, 10: 871–873.Google Scholar
  3. 3.
    Klugman KP: Pneumococcal resistance to the third generation cephalosporins: clinical, laboratory and molecular aspects. International Journal of Antimicrobial Agents 1994, March, Vol. 4 (1).Google Scholar
  4. 4.
    Goldstein FW, Geslin P, Acar JF, French Study Group Comparative activity of teicoplanin and vancomycin against 400 penicillin susceptible and resistantStreptococcus pneumoniae. European Journal of Clinical Microbiology and Infectious Diseases 1994, 13: 33–34.Google Scholar
  5. 5.
    Appelbaum PC, Spangler SK, Crotty E, Jacobs MR Susceptibility of penicillin sensitive and resistant strains ofStreptococcus pneumoniae to new antimicrobial agents, including daptomycin, teicoplanin, cefpodoxime and quinolones. Journal of Antimicrobial Chemotherapy 1989, 23: 509–516.PubMedGoogle Scholar
  6. 6.
    Lawrence T, Rotstein C, Beam TR, Gorzynski EA, Amsterdam D In vitro activities of ramoplanin, selected glycopeptides, fluoroquinolones, and other antibiotics against clinical bloodstream isolates of gram-positive cocci. Antimicrobial Agents and Chemotherapy 1993, 37: 896–900.PubMedGoogle Scholar
  7. 7.
    Rodriguez-Tudela JL, Felipe FL, Martinez-Suarez JV, Fenoll A Comparative in vitro activity of four peoptide antibiotics against penicillin-resistantStreptococcus pneumoniae isolated from cerebrospinal fluid. Journal of Antimicrobial Chemotherapy 1992, 29: 299–302.PubMedGoogle Scholar
  8. 8.
    Neal TJ, O'Donoghue MAT, Ridgeway EJ, Allen KD In vitro activity of ten antimicrobial agents against penicillin-resistantStreptococcus pneumoniae. Journal of Antimicrobial Chemotherapy 1992, 30: 39–46.Google Scholar
  9. 9.
    Felmingham D, Foxall P, O'Hare M, Grüneberg R The bactericidal activity of vancomycin and teicoplanin againstStreptococcus pneumoniae. Scandinavian Journal of Infectious Diseases 1990, Supplement 70: 20–25.Google Scholar
  10. 10.
    Barakett V, Lesage D, Delisle F, Vergez P, Petit JC Killing kinetics of vancomycin and rifampicin tested alone and in combination against penicillin-resistantStreptococcus pneumoniae. European Journal of Clinical Microbiology & Infectious Diseases 1993, 12: 69–71.Google Scholar
  11. 11.
    Friedland IR, Paris M, Ehrett S, Hickey S, Olsen K, McCracken GH Evaluation of antimicrobial regimens for treatment of experimental penicillin- and cephalosporin-resistant pneumococcal meningitis. Antimicrobial Agents and Chemotherapy 1993, 37: 1630–1636.PubMedGoogle Scholar
  12. 12.
    Stahl JP, Croize J, Wolff M, Garaud JJ, Leclercq P, Vachon F, Micoud M Poor penetration of teicoplanin into cerebrospinal fluid in patients with bacterial meningitis. Journal of Antimicrobial Chemotherapy 1987, 20: 141–142.PubMedGoogle Scholar
  13. 13.
    Viladrich PF, Gudiol F, Linares J, Pallares R, Sabate I, Rufi G, Ariza J Evaluation of vancomycin for therapy of adult pneumococcal meningitis. Antimicrobial Agents and Chemotherapy 1991, 35: 2467–2472.PubMedGoogle Scholar
  14. 14.
    Beam TR Vancomycin therapy of experimental pneumococcal meningitis caused by penicillin-sensitive and resistant strains. Journal of Antimicrobial Chemotherapy 1982, 7: 89–99.Google Scholar
  15. 15.
    McCracken GH Jr, Sakata Y Antimicrobial therapy of experimental meningitis caused byStreptococcus pneumoniae strains with different susceptibilities to penicillin. Antimicrobial Agents and Chemotherapy 1985, 27: 141–145.PubMedGoogle Scholar
  16. 16.
    Pallares R, Gudiol F, Linares J, Ariza J, Rufi G, Murgui L, Dorca J, Viladrich PF Risk factors and response to antibiotic therapy in adults with bacteremic pneumonia caused by penicillin-resistant pneumococci. New England Journal of Medicine 1987, 317: 18–22.PubMedGoogle Scholar
  17. 17.
    Jackson MA, Shelton S, Nelson JD, McCracken GH Relatively penicillin-resistant pneumococcal infections in pediatric patients. Paediatric Infectious Disease 1984, 3: 129–132.Google Scholar
  18. 18.
    Sacho H, Klugman KP, Koornhof HJ, Ruff P Community acquired pneumonia in an adult due to a multiply resistant pneumococcus. Journal of Infection 1987, 14: 188–189.CrossRefPubMedGoogle Scholar
  19. 19.
    Rahman S, Smith MA, Alperstein P, France K A case of bacteremia due to resistantStreptococcus pneumoniae. Clinical Infectious Diseases 1992, 14: 1140–1141.PubMedGoogle Scholar
  20. 20.
    Spanjaard L, Westra M, Caron HN, Overweg-Plandsoen WCG, de Groot CJ, Dankert J Meningitis due to a multiply resistantStreptococcus pneumoniae in a child in the Netherlands. Scandinavian Journal of Infectious Diseases 1992, 24; 117–118.PubMedGoogle Scholar

Copyright information

© Friedr. Vieweg & Sohn Verlagsgesellschaft mbH 1994

Authors and Affiliations

  • K. P. Klugman
    • 1
  1. 1.Department of Medical MicrobiologyUniversity of the Witwatersrand and South African Institute for Medical ResearchJohannesburgSouth Africa

Personalised recommendations