Geistlich TauroSept®

Prevention and treatment of CVAD infections through broad antimicrobial activity

TauroSept® contains the antimicrobial chemotherapeutic agent taurolidine 2%. Unlike antibiotics, taurolidine acts via a chemical reaction with bacterial cell wall structures. Microbes are killed and resulting toxins are inactivated; the destruction time in vitro is 15 – 30 minutes. Taurolidine has an extremely broad antibacterial and antimycotic spectrum, which also includes methicillin- and vancomycin-resistant bacteria (MRSA, VISA and VRE).9,11,12
Preventive instillation of Geistlich TauroSept® helps to avoid impending catheter and port colonisation. When CVAD colonisation already exists the microbial contamination can be eliminated by the therapeutic use of Geistlich TauroSept® in combination with systemic antibiotics, and in many cases the removal of the CVAD can be avoided or delayed for a long time.2,7,8,13,14

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

In many years of clinical use development of microbial resistance due to taurolidine has so far never been observed. Because of the special mechanism of action of taurolidine, in which a reaction with the bmicrobial cell wall occurs directly, development of resistance is unlikely and not to be expected, in contrast to antibiotics.4,5,15

 

Interference with biofilm development through Inhibition of microbial colonisation

Even at low concentrations, taurolidine causes a loss of bacterial fimbriae and flagellae. Due to the change in the bacterial surfaces, the capacity to form colonies is lost. Adhesion of microbes to the surfaces of epithelia and biomaterials is prevented. These antiadhesive properties of taurolidine counteract biofilm formation.1,3,6

 

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 staphylo-coagulase-induced coagulation occurring, especially at the CVAD tip, is therefore reduced. 10

 

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 taurolidin 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).7 In the body, taurolidine is metabolised rapidly via the meta-bolites 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.11


References:

  1. Beutel K, Simon A. (2005). Diagnostik und Therapie Katheterassoziierter Infektionen in der pädiatrischen Onkologie. Klin Padiatr. 217  Suppl 1: S 91–100.

  2. Bisseling, TM. 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. Clinical Nutrition doi: 10.1016/j.clnu.2009.12.2005.

  3. Blenkharn JI. (1988). Sustained anti-adherence activity of taurolidine (Taurolin) and noxythiolin (Noxyflex S) solutions. J Pharm Pharmaco. J 40(7): 509–11.

  4. Blenkharn JI. (1987). The antibacterial and anti-endotoxin activity of taurolidine in combination with antibiotics. Surg Res Commun 2: 583–586.

  5. Browne M K, Leslie G B, Pfirrmann R W. (1976) Taurolin, a new chemotherapeutic agent. J ApplBacteriol. 41: 363–368.

  6. Gorman SP, McCafferty DF, et al. (1987). Reduced adherence of microorganisms to human mucosal epithelial cells following treatment with Taurolin, a novel antimicrobial agent. J Appl Bacteriol. 62(4): 315–20.

  7. Jurewitsch B, Jeejeebhoy KN. (2005). Taurolidine lock: the key to prevention of recurrent catheter-related bloodstream infections. Clin Nutr. 24(3): 462–5.

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

  9. Noesner K, Focht J. (1994). In–vitro-Wirksamkeit von Taurolidin und 9 Antibiotika gegen klinische Isolate aus chirurgischem Einsendegut sowie gegen Pilze. Chirurgische Gastroenterologie 10 (suppl 2): 80–89.

  10. Reinmüller J., Mutschler W, et al. (1999). Hemmung der Staphylokokken-Koagulase durch Taurolin. Hämostasiologie 19:94-7.

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

  12. Traub WH, Leonhard B, et al.( 1993). Taurolidine: in vitro activity against multiple- antiibioticresistant, nosocomially significant clinical isolates of  Staphylococcus aureus, Enterococcus faecium, and diverse Enterobacteriaceae. Chemotherapy. 39(5): 322–30.

  13. Wanten, G. J., M. Willems, et al. (2008). Taurolidine versus heparin lock to prevent catheter related bloodstream  infections (crbsi) in patients on home parenteral nutrition: a prospective randomized trial. 30th congress of espen, Florence.

  14. Weber, M. et al. (2009). Indikationsspektrum und perioperatives Management bei i.v.-Portsystemexplantation – Alternative Taurolingabe bei i. v.- Portsysteminfektion. Zentralbl Chir 134: 350–356.

  15. Olthof ED. et al. (2012). Absence of microbial adaptation to taurolidine in patients on home parenteral nutrition, who develop catheter related bloodstream infections and use taurolidine locks. Clinical nutrition (2012) http://dx.doi.org/10.1016/j.clnu.2012.11.014