Anti-gram-positive agents. What we have and what we would like.

The usefulness of many anti-Gram-positive antibiotics is being compromised by the spread of antibiotic resistance in bacteria. The most reliable agents for serious infections are the glycopeptide agents vancomycin and teicoplanin. The appropriate maintenance dosage for teicoplanin in serious infections is 6 mg/kg/day, i.e. usually 400 mg/day. There are 3 exceptions for which the daily maintenance dosage should be 12 mg/kg/day and these are intravenous drug abusers, septic arthritis (but not osteomyelitis), and Staphylococcus aureus endocarditis treated with teicoplanin monotherapy. When teicoplanin is given at these doses, it achieves clinical and bacteriological results that are equivalent to those obtained with vancomycin, irrespective of pathogen or type of infection. The toxicity profile favours teicoplanin over vancomycin, especially when other, potentially toxic, drugs are coadministered. Teicoplanin also has an advantage in terms of ease and convenience of administration, which, together with its lack of need for routine blood level monitoring, facilitates its use outside hospital. New agents hold some promise for the future; however, oral agents, if developed, could present the risk of being overused, which might compromise their long term utility.