Clinical efficacy and safety in patients treated with teicoplanin with a target trough concentration of 20 μg/mL using a regimen of 12 mg/kg for five doses within the initial 3 days

Abstract

Background: A trough concentration (C min) ≥20 μg/mL of teicoplanin is recommended for the treatment of serious methicillin-resistant Staphylococcus aureus (MRSA) infections. However, sufficient clinical evidence to support the efficacy of this target C min has not been obtained. Even though the recommended high C min of teicoplanin was associated with better clinical outcome, reaching the target concentration is challenging. Methods: Pharmacokinetics and adverse events were evaluated in all eligible patients. For clinical efficacy, patients who had bacteremia/complicated MRSA infections were analyzed. The primary endpoint for clinical efficacy was an early clinical response at 72-96 h after the start of therapy. Five dosed of 12 mg/kg or 10 mg/kg was administered as an enhanced or conventional high loading dose regimen, respectively. The C min was obtained at 72 h after the first dose. Results: Overall, 512 patients were eligible, and 76 patients were analyzed for treatment efficacy. The proportion of patients achieving the target C min range (20-40 μg/mL) by the enhanced regimen was significantly higher than for the conventional regimen (75.2% versus 41.0%, p < 0.001). In multivariate analysis, C min ≥ 20 μg/mL was an independent factor for an early clinical response (odds ratio 3.95, 95% confidence interval 1.25-12.53). There was no significant difference in the occurrence of adverse events between patients who did or did not achieve a C min ≥ 20 μg/mL. Conclusion: A target C min ≥ 20 μg/mL might improve early clinical responses during the treatment of difficult MRSA infections using 12 mg/kg teicoplanin for five doses within the initial 3 days.

Dose Optimization of Teicoplanin for Critically Ill Patients With Renal Dysfunction and Continuous Renal Replacement Therapy: Experience From a Prospective Interventional Study

“…The results showed that CL of TEI in the CVVHDF mode was 5.8 ± 4.2 ml/h/kg, which was higher than that of CVVH and the CVVHD mode ( Bellmann et al, 2010 ). The size of the unbound TEI fraction and trough concentrations correlates inversely with the plasma albumin level ( Yano et al, 2007 ; Brink et al, 2015 ; Ueda et al, 2020 ). However, no studies have confirmed whether hypoalbuminemia enhanced hemofilter clearance.…”

Validation of Vancomycin Area under the Concentration—Time Curve Estimation by the Bayesian Approach Using One-Point Samples for Predicting Clinical Outcomes in Patients with Methicillin-Resistant Staphylococcus aureus Infections

“…Because the population is highly heterogeneous regarding the source of infection, we divided the patients into high/moderate and low-risk infections. High/moderate risk infections consisted of bloodstream infections and complicated infections (endocarditis, ventilator-associated pneumonia, osteomyelitis and arthritis infections, and central nervous system infections) [ 19 ]. Low-risk infections included skin and soft tissue infections, urinary tract infections, intra-abdominal infections, and cases of pneumonia with the exception of ventilator-associated pneumonia.…”

Are Antibiotics Appropriately Dosed in Critically Ill Patients with Augmented Renal Clearance? A Narrative Review

“…No association was reported between teicoplanin-induced nephrotoxicity and its trough concentrations [ 42 ]. Teicoplanin trough concentrations ≥20 mg/L compared with <20 mg/L showed no significant difference in the rate of adverse events in patients with MRSA infections [ 38 ]. Although no teicoplanin-induced renal impairment was reported in trough concentrations ≥10 mg/L, the hepatotoxicity rate was 10% [ 43 ].…”