Does surgical prophylaxis with teicoplanin constitute a therapeutic advance?

ABSTRACT

Antibiotic prophylaxis has become standard care not only in operations characterized by high infection rates but also in the vast majority of clean surgical procedures, including those that use foreign materials, grafts or prosthetic devices as well as non-implant surgery. While use of antibiotics in clean implant surgery is undisputed, it is still controversial in clean non-implant surgery. As antibiotic prophylaxis should be directed against expected pathogens, the glycopeptides are considered suitable alternative antibiotics to first and second generation cephalosporins in clean surgical procedures associated with a high risk of wound infections due to Gram-positive bacteria, including methicillin-resistant, and for patients allergic to beta-lactam antibiotics. In deciding whether to use a glycopeptide for prophylaxis, the current wound infection rates with methicillin-resistant Staphylococcus aureus and methicillin-resistant Staphylococcus epidermidis at single institutions need to be considered, to limit the use of glycopeptides to wards where the incidence of methicillin resistance is high. Of the two available glycopeptides, teicoplanin may be preferable to vancomycin for peri-operative prophylaxis because of its excellent tissue penetration, as indicated by the large volume of distribution, lower toxicity, and particularly long half-life, allowing single-dose administration in several surgical procedures. Clinical trials with teicoplanin prophylaxis in several types of clean surgical procedures including orthopedic, cardiac, vascular and dental operations, have shown it to be efficacious. This review focuses on results from clinical studies with this glycopeptide as prophylaxis in clean surgery.