Therapeutic drug monitoring of the teicoplanin trough level after the. For the maintenance dose we divided patients into two groups. The oral dose recommendation for teicoplanin is 100400 mg by mouth every 12 hours for 10 days. For various combinations of clcr and body weight, we checked the calculated doses using a therapeutic drug monitoring tdmsupporting software and developed a nomogram. Impact of teicoplanin maintenance dose and mic values on the clinical outcomes of patients treated for methicillinresistant staphylococcus aureus bacteremia chingyen tsai,1 chenhsiang lee,1,2 chunchih chien,3 iling chen4 1division of infectious diseases, department of medicine, kaohsiung chang gung memorial hospital, kaohsiung, taiwan. Wash eyes with plenty of clean and cool water for at least 10 minutes while pulling eyelids up, and seek medical assistance. Therapeutic drug monitoring and dose adjustment were not conducted. How you will be given teicoplanin the recommended dose is adults and children 12 years and over with no kidney problems skin and soft tissue, lung and urinary tract infections starting dose for the first three doses.
The dosing regimen was optimized based on the final model. Population pharmacokinetics and dosing optimization of. Teicoplanin contains two chlorinated positions, 2 3cltyr and 6 3cl. Healthcare professionals are asked to report any suspected adverse reactions. Vaecmo has never been determined by therapeutic drug monitoring. Dose adjustment for renal impairment cockcroftgault crcl estimates using the creatinine clearance calculator should be used for drug dosing rather than the automated mdrd egfr produced by the clinical chemistry laboratory available on notis. Teicoplanin monitoring of serum teicoplanin levels is required for patients being treated for endocarditis or serious staphylococcal infections i. Targocid 400mg powder for solution for injectioninfusion.
Teicoplanin dose depends on the type of infection being treated. In severe renal insufficiency creatinine clearance less than 30 mlmin and in haemodialysed patients. The elimination half life is 70100 hours with most of the dose being excreted unchanged in the urine. Monitoring of plasma teicoplanin concentrations is necessary when high doses of the antibiotic are administered. With the current recommended dose of 10 mg kg 1 day 1, 41 children 48% had subtherapeutic steadystate trough concentrations c ss,min 345 was the pkpd target of teicoplanin, and the mcs was used to calculate the probability of reaching that target. Multivariate analysis indicated that the only factor significantly correlated with teicoplanin c min both with actual and normalized dose per kg teicoplanin values on days 2 and 3 of therapy was the administered dose kg, whereas other factors besides dose kg, namely cl cr and age, appeared to be inversely correlated with teicoplanin trough. Rapid attainment of optimal trough concentrations in organ failure.
The nomogram would be useful for initial dose adjustment to promptly reach an effective serum trough concentration and avoid adverse events of teicoplanin. Note teicoplanin doses are based on actual bodyweight abw and dosing frequency after loading is based on renal function. The results of the mcs were expressed as the probability of target attainment pta and the cumulative. Estimated absorption rate constant betweensubject variability was 0. However, trough teicoplanin concentrations 20 and 30 mgl are considered necessary for the treatment of endocarditis and for deepseated bone and joint infections caused by s. Chlorination is thought to occur at a very early point in the biosynthesis prior to phenolic oxidative coupling, with the possibility of tyrosine or. Teicoplanin targocid, sanofiaventis is a glycopeptide antibiotic that has bactericidal activity against aerobic and anaerobic grampositive bacteria including multiresistant staphylococci. While not in all patients, therapeutic drug monitoring may be of value in severe sepsis, mrsa infection, deepseated staphylococcal infection, bone and joint infection, iv drug misusers, infective endocarditis, unexpected therapeutic failure, and elderly or renally impaired patients. The use and therapeutic drug monitoring of teicoplanin in the. Clinical pharmacokinetics of teicoplanin springerlink. Teicoplanin is added to the dialysis solution at a concentration of 20 mgl. This medicinal product is subject to additional monitoring. Use normal dose regimen on days 14, then use normal maintenance dose every 48 hours if egfr 3080 mlminute1.
Mar, 2008 we administrated an initial loading dose of 10 mgkg every 12 hour for three doses, followed by a maintenance dose based on therapeutic drug monitoring and therapy personalization by bayesian computerized software. Daptomycin versus teicoplanin for bloodstream infection due to methicillinresistant staphylococcus aureus with a high teicoplanin minimal inhibitory concentration. A standard twocompartment pk model was developed, followed by models. The optimal loading dose of teicoplanin in patients receiving venoarterial extracorporeal. Teicoplanin concentrations were best described by a twocompartment model with clearance predicted by estimated glomerular filtration rate. Teicoplanin, drug monitoring, loading dose, dosing regimen. Dose adjustments in renal impairments not required until the fourth day of treatment.
Patients in these groups will generally be on the higher dose of 1012mg per kg body weight per day normally 800mg. After teicoplanin is given intravenously, there is a biphasic distribution, followed by a prolonged elimination period. Recommended initial loading dose of teicoplanin, established. Teicoplanin inpatient dosing guidelines for patients.
Population pharmacokinetics of teicoplanin administered by. Teicoplanin treatment was performed with software based monitoring of teicoplanin concentrations. For uncomplicated line infections without sepsis, bacteraemia or significant cellulitis or moderate skin and soft tissue infection, lower doses are used see lower dosing regimen for teicoplanin below. We compared serum chemistry parameters and sequential organ failure assessment sofa scores in patients with initial teicoplanin trough concentrations monitoring of vancomycin trough serum levels is recommended in the view of avoiding nephrotoxicity 4. The putative halogenase orf8 has been proposed to catalyze the halogenation on both amino acids. Teicoplanin therapeutic drug monitoring in critically ill patients. Recommended initial loading dose of teicoplanin, established by. Teicoplanin prescribing and therapeutic drug monitoring clinical. Therapeutic drug monitoring of teicoplanin in haematological. Loading dose required to achieve rapid therapeutic. Adjust teicoplanin doses after the trough level is reported, do not withhold doses. This study found that the qualifying rate of c min 10 mgl was higher in group 1 loading dose group than in group 2 unloaded or underloaded, 54.
In changing renal function take trough levels more frequently i. Is therapeutic drug monitoring of teicoplanin useful. Doses of 10 mgkg are necessary to achieve adequate bone concentrations. Adjust teicoplanin doses after the trough level is reported, do not withhold doses pending trough level reports. Therefore, the use of an appropriate loading dose is recommended to achieve earlier therapeutic concentrations 2, 4, 5.
Therapeutic drug concentrations of teicoplanin in clinical settings. If clcr equal to or less than 20mlmin treatment with teicoplanine may be given only if monitoring of serum drug concentration can be guaranteed. The median number of sc injections per patient was 39. Initially 10 mgkg every 12 hours for 3 doses, then 610 mgkg once daily. Mar 21, 2014 therapeutic drug monitoring tdm of teicoplanin is not routine because of the lack of evidence for dose related adverse effects of teicoplanin. An initial loading procedure has been recommended for teicoplanin to enable prompt reaching of the optimal serum trough level 1015 gml. Iv continuous ambulatory peritoneal dialysis capdassociated peritonitis 6 mgkg as single loading dose. Recent studies and metaanalyses have indicated that doses higher than those recom mended in the data sheet may be needed to achieve predose. However, the dose of teicoplanin that should be administered to patients with varying renal function levels remains inconclusive. Teicoplanin inpatient dosing guidelines for patients aged. Therapeutic drug monitoring tdm of teicoplanin is not routine because of the lack of evidence for dose related adverse effects of teicoplanin 3.
For people with mild and moderate kidney problems the maintenance dose will be given every two days, or. Teicoplaninbased antimicrobial therapy in staphylococcus. The drug should be reconstituted with water precisely in accordance with the manufacturers directions. Recommended initial loading dose of teicoplanin, established by therapeutic drug monitoring, and outcome in terms of optimal trough level. Prescribing and monitoring intravenous teicoplanin in adults. Therapeutic drug concentrations of teicoplanin in clinical. Teicoplanin prescribing and therapeutic drug monitoring.
The optimal dosage of teicoplanin was previously established, and an optimal trough. Teicoplanin is a protected antimicrobial and as such should only be initiated following consultation with an infection specialist. Initially 16 mgkg for 1 dose, followed by 8 mgkg once daily, subsequent dose to be administered 24 hours after initial dose, doses to be given by intravenous infusion. Teicoplanin was widely used in the uk, although vancomycin was more popular as a choice of glycopeptide. Teicoplanin has a long serum halflife, and therefore it takes time to reach a steadystate concentration. Pdf tools for the individualized therapy of teicoplanin for. At last, we expect to optimize the teicoplanin dose for those patients by. Full text impact of teicoplanin maintenance dose and mic. Building the teicoplanin dose optimization software. Pdf recommended initial loading dose of teicoplanin, established. Sep 30, 2012 the glycopeptide antibacterial teicoplanin has become increasingly popular in the last decade with the rise in infections related to methicillinresistant staphylococcus aureus. Multivariate analysis indicated that the only factor significantly correlated with teicoplanin c min both with actual and normalized dose per kg teicoplanin values on days 2 and 3 of therapy was the administered dosekg, whereas other factors besides dosekg, namely cl cr and age, appeared to be inversely correlated with teicoplanin trough.
We conclude that loading doses of teicoplanin 6 mgkg every. Of the several methods available to measure concentrations in serum, fluorescence polarisation immunoassay has high. Statistical analyses were performed using stata software, version 14. Each vial contains 400 mg teicoplanin equivalent to not less than 400,000 iu. Teicoplanin was given at a loading dose of 400 or 800 mg on the first day, followed by maintenance doses of 200 or 400 mg. Population pharmacokinetics of teicoplanin were analyzed using nonmem software. Therapeutic drug monitoring and opportunistic samples n 143 were available for analysis. We performed a retrospective study of teicoplanin tdm focusing on the dose serum concentration relationship and clinical outcomes in a clinical setting. We administrated an initial loading dose of 10 mgkg every 12 hour for three doses, followed by a maintenance dose based on therapeutic drug monitoring and therapy personalization by bayesian computerized software. Adults and elderly patients with kidney problems if you have kidney problems, your dose will usually need to be lowered after the fourth day of treatment. Targocid 400mg powder for solution for injectioninfusion or. The clinical value of teicoplanin therapeutic drug monitoring. List of approved drugs containing teicoplanin listed with health canada in the drug product database dpd. Fewer than 25% recommended teicoplanin tdm during routine use, the main reasons being perceived lack of toxicity and lack of evidence for the use of teicoplanin tdm.
Teicoplanin health canada drug product database dpd. Remove contact lenses, if present and if it is easy to do. Teicoplanin was mostly administrated via iv route n 51, 78. The mean initial dose mid over the first 3 days was calculated as. Daptomycin versus teicoplanin for bloodstream infection due. However, measuring of teicoplanin plasma concentrations may help to optimize therapy in some patients. Teicoplanin prescribing and therapeutic drug monitoring clinical guideline v2. Teicoplanin therapeutic drug monitoring in critically ill. The use and therapeutic drug monitoring of teicoplanin in the uk. From january 2017 to december 2018, patients receiving teicoplanin. Teicoplanin treatment was performed with softwarebased monitoring of. Rapid attainment of optimal trough concentrations in organ. Therapeutic drug monitoring tdm of teicoplanin is aimed at minimizing the clinical impact of pharmacokinetic variability. Pdf tolerability and plasma drug level monitoring of.
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