Geistlich TauroSept®

Prevention and treatment of CVAD infections through broad anti-microbial activity

Geistlich TauroSept® contains the antimicrobial chemotherapeutic agent taurolidine 2 %. Unlike antibiotics, taurolidine acts via a chemical reaction with the microbial cell wall. Microbes are killed and resulting toxins are inactivated; the destruction time in vitro is 15–30 minutes. Taurolidine has an extremely broad antimicrobial and antimycotic spectrum, which also includes methicillin- and vancomycin-resistant bacteria (MRSA, VISA and VRE). (1, 2, 3, 4) Preventive instillation of Geistlich TauroSept® helps to avoid impending CVAD colonisation. (5, 6, 7, 8) When CVAD colonisation already exists the microbial contamination can be eliminated by the therapeutic use of Geistlich TauroSept® in combination with systemic antibiotics. In many cases the removal of the CVAD can be avoided or delayed for a long time. (9, 10)

 

Reliability in long-term use due to the absence of development of microbial resistance

In many years of clinical use development of microbial resistance due to taurolidine has never been observed. Because of the special mechanism of action of taurolidine, in which a reaction with the microbial cell wall occurs directly, development of resistance is unlikely and not to be expected in contrast to antibiotics. (11, 12)

 

Interference with biofilm development through inhibition of microbial colonisation

Even at low concentrations, taurolidine causes a loss of microbial fimbriae and flagellae. Due to the change in the microbial surfaces, the capacity to form colonies is lost and the adhesion of microbes to the surfaces of epithelia and biomaterials is prevented. These antiadhesive properties of taurolidine counteract the biofilm formation. (13, 14)

 

Promotion of intraluminal haemodynamics by reducing local pathological coagulation phenomena

Depending on duration of exposure and concentration, taurolidine causes inhibition of staphylocoagulase-mediated coagulation, which cannot be influenced by heparin. The risk of pathological staphyloco-agulase-induced coagulation occurring especially at the CVAD tip is therefore reduced. (15)

 

Safety in use due to outstanding systemic tolerability

Taurolidine is also licensed as an active pharmaceutical ingredient for the local treatment of infections such as peritonitis; up to 200 ml of taurolidine 2 % are instilled daily into the abdominal cavity and absorbed fully through the peritoneum. So far, no systemic side effects have been identified. The safety of taurolidine has also been confirmed in clinical studies with long-term intravenous administration of high doses (up to 20 g daily).16 In the body, taurolidine is metabolised rapidly via the metabolites taurultam and methylol taurinamide, which also have an anti-microbial action, to taurine, an endogenous aminosulphonic acid, CO2 and H2O. Therefore, no toxic effects are known or expected in the event of accidental injection.17

 

References:

  1. Olthof, E. D., R. J. Rentenaar, et al. (2013). “Absence of microbial adaptation to taurolidine in patients on home parenteral nutrition who develop catheter related bloodstream infections and use taurolidine locks.” Clin Nutr 32 (4): 538–42.

  2. Olthof, E. D., R. Nijland, et al. (2015). “Microbiocidal effects of various taurolidine containing catheter lock solutions.” Clin Nutr 34 (2): 309–14.

  3. Torres-Viera, C., C. Thauvin-Eliopoulos, et al. (2000). “Activities of taurolidine in vitro and in experimental enterococcal endocarditis.” Antimicrob Agents Chemother 44(6): 1720-4.

  4. Traub, W. H., B. Leonhard, et al. (1993). “Taurolidine: in vitro activity against multiple-antibiotic-resistant, nosocomially significant clinical isolates of Staphylococcus aureus, Enterococcus faecium, and diverse Enterobacteriaceae.” Chemotherapy 39(5): 322–30.

  5. Bisseling, T. M., M. C. Willems, et al. (2010). “Taurolidine lock is highly effective in preventing catheter-related bloodstream infections in patients on home parenteral nutrition: a heparin- controlled prospective trial.” Clin Nutr 29(4): 464–8.

  6. Jonkers, C., K. I. Looman, et al. (2012). “Incidence of central venous catheter related bloodstream infections in adults and children on home parenteral nutrition: heparin versus taurolidine catheter lock “ Clinical Nutrition Supplements 7(1): 203–204.

  7. Jurewitsch, B., T. Lee, et al. (1998). “Taurolidine 2 % as an antimicrobial lock solution prevention of recurrent catheter-related bloodstream infections.” JPEN J Parenter Enteral Nutr 22(4): 242–4.

  8. Olthof, E. D., M. W. Versleijen, et al. (2014). “Taurolidine Lock Is Superior to Heparin Lock in the Prevention of Catheter Related Bloodstream Infections and Occlusions.” PLoS One 9 (11): e111216.

  9. Koldehoff, M. and J. L. Zakrzewski (2004). “Taurolidine is effective in the treatment of central venous catheter-related bloodstream infections in cancer patients.” Int J Antimicrob Agents 24(5): 491–5.

  10. Weber, M., F. Meyer, et al. (2009). “[Spectrum of indications and perioperative management in i. v. port-a-cath explantation-alternative administration of taurolin in case of i. v. port-a-cath infection].” Zentralbl Chir 134(4): 350–6.

  11. Gorman, S. P., D. F. McCafferty, et al. (1987). “Reduced adherence of micro-organisms to human mucosal epithelial cells following treatment with Taurolin, a novel antimicrobial agent.” J Appl Bacteriol 62(4): 315–20.

  12. Blenkharn, J. I. (1987). “The antibacterial and anti-endotoxin activity of taurolidine in combination with antibiotics.” Surg Res Comm 2: 149–155.

  13. Blenkharn, J. I. (1988). “Sustained anti-adherence activity of taurolidine (Taurolin) and noxythiolin (Noxyflex S) solutions.” J Pharm Pharmacol 40(7): 509–11.

  14. Gorman, S. P., D. F. McCafferty, et al. (1987). “Reduced adherence of micro-organisms to human mucosal epithelial cells following treatment with Taurolin, a novel antimicrobial agent.” J Appl Bacteriol 62(4): 315–20.

  15. Reinmuller, J. (1999). “[The influence of taurolidine on physiological and pathological blood coagulation and implications for its use].” Zentralbl Chir 124 Suppl 4: 13–8.

  16. Gong, L., H. E. Greenberg, et al. (2007). “The pharmacokinetics of taurolidine metabolites in healthy volunteers.” J Clin Pharmacol 47(6): 697–703.

  17. Knight, B. I., G. G. Skellern, et al. (1981). “The characterisation and quantitation by high- performance liquid chromatography of the metabolites of taurolin.” Br J Clin Pharmacol 12 (3): 439–40.