A trial looking at teicoplanin to treat infection in children's central lines (SC 1999 01)

Cancer type:

Children's cancers

Status:

Results

Phase:

Phase 3

This trial was looking at different ways of using teicoplanin to treat infections in central lines. It was for children (from 2 months old) and young people.

More about this trial

Children or adults might have a central line as part of their treatment for cancer or a blood disorder. A central line is a long plastic tube that is usually placed in the arm or chest. This goes through the skin into a large vein near the heart. A central line is sometimes called a long line or the medical name is a central venous catheter.

The advantage of a central line is that you can have chemotherapy through it and blood samples taken without having injections or needles.

The line can stay in place for many months. But there is a risk that it may become infected with bacteria. We all have bacteria on our skin and this is usually harmless. When a person has a central line, the bacteria can enter it and get into the bloodstream. This can cause an infection called septicaemia and you become very unwell as a result.

Teicoplanin is an antibiotic Open a glossary item used to treat infection in central lines. The standard way to use teicoplanin is for children to have it as an injection into their line that is flushed straight away into the bloodstream. This is called a bolus injection.

Doctors wanted to find out if there was another way of giving teicoplanin, which would be better at treating infections in central lines. This trial followed 2 groups of children and young people who had one of the following:

teicoplanin as a bolus injection
teicoplanin treatment over a longer period of time - called prolonged exposure

The results of the 2 groups were compared to find out which was the best way to treat septicaemia.

The researchers also looked at the type of central line that children had and if this had an impact on treatment. Some children in this trial had 1 tube in their central line (called single lumen). Other children had 2 separate tubes in their central line (dual lumen).

Summary of results

The trial team found that teicoplanin was a useful treatment for those children who had prolonged treatment and a dual lumen central line.

This phase 3 trial recruited 832 children and young people across the UK.

There were 2 different groups in this trial and the trial was randomised. This means that those taking part were put into the groups by a computer. Neither they nor their doctor could decide which group they were in. In the event of developing a central line infection, children would have teicoplanin treatment in one of these groups:

bolus injection group
prolonged exposure group

Out of the 832, one hundred and thirty four patients developed an infection in their central line and then took part in the next step of the trial.

Bolus injection group
69 children had an injection of teicoplanin into their central line that was flushed straight into their bloodstream.

Prolonged exposure group
65 children had teicoplanin over a longer period of time. For their first dose of teicoplanin, they had an infusion through their line (and into the bloodstream) over a couple of hours.

For further doses of antibiotics, they had teicoplanin in one of the following ways:

as an infusion through the line over a couple of hours
as an injection which was left in the line for several hours, before flushing it into the bloodstream. This is called line lock (locking the antibiotic into the line)

For these further doses, the doctor decided the best way for their patient to have it. This depended on the individual circumstances of the child.

Both groups had regular treatments with teicoplanin over 7 days.

The researchers looked at how successful teicoplanin was. They considered treatment to have failed if any of the following happened:

a child developed the same type of infection within 4 weeks of starting teicoplanin treatment
the central line was removed because antibiotic treatment wasn’t working
a child’s treatment with antibiotic treatment was changed because the first antibiotic was not working
a blood test called a blood culture still showed infection 3 days after teicoplanin treatment ended
a child had to stop teicoplanin because the side effects were too severe

Overall treatment with teicoplanin was successful in 107 out of the 134 children and young adults.

51 children had successful treatment in the bolus injection group
56 children had successful treatment in the prolonged exposure group

The researchers also looked at the success of treatment in the 2 groups, depending on the type of central line they had.

Out of the 134 children:

48 had 1 tube (single lumen) in their central lines
86 had 2 separate tubes (dual lumen) in their central lines

They looked at those children with a single lumen central line. They found no significant difference between the bolus injection group and the prolonged exposure group.

In those children who had a dual lumen central line:

28 children had successful treatment in the bolus injection group
42 children had successful treatment in the prolonged treatment group

So they did see an improvement in those children with a dual lumen who had prolonged treatment with teicoplanin.

The trial team concluded that more research is needed in this area and particularly the use of teicoplanin in children. They recommended that further research should focus on locking the antibiotic in the central line to see if is it a better treatment for central line infections.

We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists (peer reviewed Open a glossary item ) but may not have been published in a medical journal. The figures we quote above were provided by the research team. We have not analysed the data ourselves.