Analyses of teicoplanin concentrations from 1994 to 2006 from a UK assay service

Abstract

Objectives An analysis of the trough serum concentrations sent to the UK Antimicrobial Reference Laboratory for teicoplanin therapeutic drug monitoring (TDM). Methods All trough concentrations over a 13 year period were analysed and the percentages were calculated for the following: <10 mg/L (a sub-optimal concentration for all); ≥10-<20 mg/L (the target used for ordinary Gram-positive infections); ≥20-<60 mg/L (the target for all severe staphylococcal infections including endocarditis); and ≥60 mg/L (the concentration associated with toxicity). Results The percentage of patients with concentrations of <10 mg/L decreased each year to 13% in 2006. Almost 40% of the samples each year were in the ≥10-<20 mg/L range. In 1996, the percentage of samples in the ≥20-<60 mg/L range reached a study high of ∼70%. That percentage then fell to 30% and increased slowly to 50% at the end of the study. Fewer than 5% of the samples were ≥60 mg/L. Conclusions Our study shows that there is a need to increase the initial dose or extend the number of days that the loading dose is used in a significant number of patients. With such a wide optimal range and a low potential for toxicity, it is unclear why optimal therapy is not achieved in a higher percentage of patients.

Proposal of a Pharmacokinetically Optimized Dosage Regimen of Antibiotics in Patients Receiving Continuous Hemodiafiltration

“…In the same manner, the dosage regimens of TEC were calculated to achieve an AUC 0-24 h /MIC of 345 (23). The target C trough of TEC was set at 10 to 60 mg/liter because a C trough of Ͻ10 mg/liter is considered suboptimal and a C trough of Ͼ60 mg/liter is toxic (43). The MIC of the pathogen (e.g., MRSA) was set at 2 or 4 mg/liter (14,26).…”

“…However, if the MIC increased to 2 mg/liter, the dosing interval of VAN was prolonged up to 120 h to achieve a C trough of Ͻ20 mg/liter when Q outflow was equal or less than 40 ml/h/kg. In contrast, the dosing interval of TEC could be fixed at 24 h because of its broad therapeutic range of C trough (10 to 60 mg/liter) (43).…”

“…In contrast to VAN, the target AUC 0-24 h /MIC can be achieved by adjusting only the daily dose of TEC, which would be a significant advantage over VAN in clinical settings. This advantage is attributed to the broad therapeutic range of TEC (10 to 60 mg/liter) (43). Although adverse renal events are less common with TEC than with VAN (39), the tolerability of TEC at a C trough of 40 to 50 mg/liter, which is the predicted C trough in our nomogram for the pathogen with a MIC of 4 mg/liter (Table 6), has not been confirmed in a large population and needs to be investigated.…”

Enhanced loading regimen of teicoplanin is necessary to achieve therapeutic pharmacokinetics levels for the improvement of clinical outcomes in patients with renal dysfunction

“…It is generally accepted that a trough concentration (C min ) of greater than 10 μg/ml is appropriate for MRSA infections [1,[3][4][5]. However, as teicoplanin has been shown to have a lower adverse event rate than vancomycin [2], more than 20 μg/ml C min is recommended for the treatment of complicated MRSA infections [1,[3][4][5][6][7][8].…”

Quantification of teicoplanin in plasma by LC-MS with online sample clean-up and comparison with QMS® assay

“…Several authors have highlighted the importance of therapeutic drug monitoring to ensure therapeutic concentrations of teicoplanin [9][10][11]. Typically, trough plasma levels < 10 mg/L are regarded as sub-therapeutic; 10-20 mg/L are targeted for ordinary Gram-positive infections; 20-60 mg/L are targeted for severe staphylococcal infections, and ≥ 60 mg/L are regarded as toxic [12].…”