JAC pp477-81 MW3164

Teicoplanin is a glycopeptide antibiotic active against most Gram-positive organisms, including methicillinresistant Staphylococcus aureus (MRSA). In animal studies, antibiotics administered more than 3 h after bacterial contamination have no observable effect on the development of wound infection. The lowest rate of surgical wound infection in clean and clean-contaminated surgery, occurs in patients given antibiotics between 0 and 2 h before the first incision, with a significant increase in infection rate with each successive hour that antibiotics are delayed. Antibiotics that are rapidly bactericidal may be an advantage in the setting of surgical prophylaxis. Teicoplanin kills bacteria slowly and is highly proteinb o u n d . In time–kill studies the bactericidal rate of teicoplanin against staphylococci and streptococci is s i g n i ficantly lower in the presence of serum than in broth a l o n e . , 4 The slow bactericidal rate in the presence of serum has been put forward as a possible reason for the decreased efficacy of teicoplanin relative to other antibiotics in experimental endocarditis, and cardiac surgery prophylaxis. Flucloxacillin is also highly protein-bound, and is successfully used in the prophylaxis of certain surgical procedures. The in-vitro bactericidal rate of teicoplanin and flucloxacillin, in 50% serum, was compared for six clinical isolates of S. aureus from blood cultures taken during burn surgery. The concentrations of teicoplanin and flucloxacillin were adjusted hourly to simulate the pharmacokinetics previously found in patients having antibiotic prophylaxis for burns and cardiac surgery. The bactericidal rate of teicoplanin in the absence of serum is also presented.