Comparison of Teicoplanin and Vancomycin in Initial Empirical Antibiotic Regimen for Febrile Neutropenic Patients

• The primary efficacy parameter will be the Response according to the following
• definitions:
• Success: All signs and symptoms have resolved and there were no additional
• systemic antibiotics added to the study drug regimen. There were no systemic
• antifungals nor antivirals/antiparasitic drugs added within 72 hrs of start of
• study drug. For MDIs, there was no recurrence of the causative pathogen within
• 4 to 6 days after study drug discontinuation. A patient with recurrent fever
• after the EOT visit will be defined as a success as long as there is no
• additional anti-Gram(+) drugs administered within 4 to 6 days after study drug
• discontinuation.
• Failure: Death attributed to infection; clinical deterioration or microbiologic
• failure on study drug regimen; persistence of symptoms; addition of new anti-Gram(+)
• agent for persistent symptoms or new infection; resistant isolate. Addition of
• an antiviral, an antiparasitic (for a specific indication) or of an antifungal
• drug will not be considered as a failure if added 72hrs after start of study
• medication. Indeterminate: Absence of criteria enabling success/ failure a
• assessment (this definition apply to patients who are randomized but not treated
• or to patients lost to follow-up).Whenever a patient is categorized a failure,
• this classification will apply to subsequent assessments.

• Safety will be assessed for all randomized patients who received at least one dose
• of study medication. The assessment will include the incidence rate of clinical
• adverse events, and changes in laboratory values from baseline measurements. The
• incidence of adverse events by body system will be summarized by causality,
• severity, and relationship to study drug. Summaries of adverse clinical events
• ill also be presented separately by gender, race and age group.

The aim of the study is to evaluate the efficacy and safety of Teicoplanin versus Vancomycin as part of the initial antibiotic regimen in the therapy of patients with fever and neutropenia .

• Infection
• Febrile Neutropenia

• Drug: Teicoplanin
• Drug: Vancomycin

• Active Comparator: 1, Vancomycin
  Vancomycin
  Intervention: Drug: Vancomycin
• Active Comparator: 2, Teicoplanin
  Teicoplanin
  Intervention: Drug: Teicoplanin

Inclusion Criteria:

• Will initiate study drug treatment in the hospital;
• Has a life expectancy exc. 1 month.Is male or a non-pregnant, non-lactating female, who is post-menopausal, surgically sterilized; or has been using one or more birth control methods for at least two months prior to study entry.
• Effective contraception must continue for at least 30 days after treatment discontinuation;

Exclusion Criteria:

• Has a history of suspected or documented Type I hypersensitivity reaction (e.g. anaphylactic or anaphylactoid shock, respiratory distress from bronchospasm or rash) to glycopeptides (vancomycin or teicoplanin), aminoglycosides, b-lactams or cephalosporins
• Has renal dysfunction requiring dialysis ;
• Has neutropenia associated with a syndrome that is not generally thought to be associated with a high risk of bacterial infection (e.g., chronic benign neutropenia);
• Is in blast crisis of chronic myeloid leukemia;
• Has a known underlying immunocompromising disease likely to interfere with the evaluation of therapeutic response, such as infection with human immunodeficiency virus (HIV) ;
• Had isolation and identification of a specific pathogen suspected to be responsible for fever ;Has documented colonization with vancomycin-resistant Enterococcus faecium or with Enterococcus faecalis
• Had received more than one dose of a systemic (whether oral or parenteral) antibiotic within 3 calendar days preceding the initial therapy for this episode of fever;
• Has received oral vancomycin for prophylaxis of Gram-positive infection;
• Requires addition of anti-viral, anti-anaerobic or anti-fungal coverage at the same time as study medication; however, antiviral or antifungal prophylaxis is allowed, provided that it is not started at the same time than study medication.
• Has suspected, invasive fungal disease (e.g. image of necrotic pneumonia), peri-rectal infection, liver abscess, or necrotizing enterocolitis (typhlitis).
• Had a negative serum or urine laboratory pregnancy test (for all women except those post-menopausal or surgically sterilized).
• The patient has one of the following:Leukemia, lymphoma, Hodgkin's disease, solid tumors or who had undergone bone marrow transplantation (for any reason)
• Had neutropenia at the time of initiation of initial empiric antibiotic therapy, defined as <500 neutrophils/mm3 of blood; or if ³500 but <1,000 neutrophils/mm3 and expected to fall below 500 neutrophils/mm3 within 48 hours.
• Has at least one of the following conditions:
• clinically obvious, serious catheter-related infections. For a patient with documented catheter-related infection due to an organism other than coagulase negative staphylococci, the catheter has been removed within 24 hours of identification (removal over a guidewire is permitted).
• Intensive chemotherapy that produces substantial mucosal damage (i.e., high-dose cytarabine (> 1 g/m2/day, which increases the risk for penicillin resistant streptococcal infections, particularly those due to viridans streptococci);
• prophylaxis with quinolones before the onset of the febrile episode; known colonization with pneumococci that are resistant to penicillin and -cephalosporins or methicillin-resistant S. aureus; a blood culture positive for gram-positive bacteria before final identification and susceptibility