Stratégie d'utilisation des glycopeptides chez les adultes neutropéniques fébriles
Médecine et Maladies Infectieuses, ISSN: 0399-077X, Vol: 27, Issue: SPEC. ISS. NOV., Page: 979-983
1997
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Article Description
Chez les adultes neutropéniques fébriles, les glycopeptides ne devraient pas être prescrits en première intention sauf en cas de suspicion d'emblée d'une infection sévère à bactérie à Gram positif. Le taux résiduel sérique du glycopeptide doit, à notre avis, être mesuré au moins une fois initialement chez l'adulte neutropénique, car les sous-dosages liés à l'augmentation de la clairance ou du volume de distribution peuvent conduire à une inefficacité thérapeutique. La vancomycine et la teicoplanine sont aussi efficaces dans le traitement des infections à bactéries à Gram positif dans cette population avec dans certaines études une meilleure tolérance de la teicoplanine, notamment en association à des médicaments néphrotoxiques. La facilité d'utilisation de la teicoplanine lui permet d'être prescrite chez des patients en hospitalisation à domicile et le coût global des traitements doit être intégré dans la stratégie de prescription. La surveillance périodique de la sensibilité des bactéries à Gram positif aux glycopeptides doit désormais être systématique dans les unités d'onco-hématologie. Glycopeptides should not be prescribed as a first-line therapy in adults with febrile neutropenia, except in patients with presumed severe infection due to Gram positive bacteria. Trough serum levels should be monitored because of increased clearance and/or distribution volume described with such antibiotics. Both vancomycin and teicoplanin are equally effective in the management of Gram positive bacterial infections in this setting; teicoplanin seems to be better tolerated according to several studies. The easy administration of teicoplanin may facilitate the outpatient management of neutropenic adults with confirmed Gram positive infections. The global cost of such treatments has to be analyzed and the epidemiology of Gram positive bacteria resistance to glycopeptides should be carefully monitored in hematology units.
Bibliographic Details
http://www.sciencedirect.com/science/article/pii/S0399077X97802016; http://dx.doi.org/10.1016/s0399-077x(97)80201-6; http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=0031466975&origin=inward; https://linkinghub.elsevier.com/retrieve/pii/S0399077X97802016; http://linkinghub.elsevier.com/retrieve/pii/S0399077X97802016; http://api.elsevier.com/content/article/PII:S0399077X97802016?httpAccept=text/xml; http://api.elsevier.com/content/article/PII:S0399077X97802016?httpAccept=text/plain; http://dx.doi.org/10.1016/s0399-077x%2897%2980201-6; https://dx.doi.org/10.1016/s0399-077x%2897%2980201-6
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