Evaluating the optimal dose of teicoplanin with therapeutic drug monitoring: not too high for adverse event, not too low for treatment efficacy

Kim, Si-Ho; Kang, Cheol-In; Huh, Kyungmin; Cho, Sun Young; Chung, Doo Ryeon; Lee, Soo-Youn; Kim, Yae-Jean; Peck, Kyong Ran

doi:10.1007/s10096-019-03652-6

Cited by 33 publications

(32 citation statements)

References 27 publications

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“…[5][6][7] Generally, it is recommended that, for most gram-positive infections, teicoplanin C min should be maintained at least 10 mg/L (measured by high performance liquid chromatography, HPLC) or 15 mg/L (measured by fluorescence polarization immunoassay, FPIA) in clinical practice. 8,9 In addition, large interindividual and intra-individual variation of teicoplanin C min have been observed in both adult and pediatric patients, [10][11][12][13][14][15][16] and it has been reported that drug underexposure was documented in more than half of the cases. 3 Weight, serum creatinine and other clinical factors were found to be significantly correlated with the C min of teicoplanin.…”

Section: Introductionmentioning

confidence: 99%

<p>Therapeutic Drug Monitoring and Nephrotoxicity of Teicoplanin Therapy in Chinese Children: A Retrospective Study</p>

Sun

Zhang

et al. 2020

IDR

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Purpose This study aims to 1) describe the distribution characteristics of teicoplanin trough concentration ( C min ) and explore the related influencing factors and 2) evaluate the nephrotoxicity of teicoplanin in children. Patients and Methods A cohort of children who were treated with teicoplanin intravenously were included in this retrospective study. Regression analysis was performed to explore the factors associated with the fluctuations of teicoplanin C min and the development of nephrotoxicity. Classification and regression tree analysis was used to identify the population at high risk for teicoplanin nephrotoxicity. Results A total of 269 plasma samples from 186 children were collected. Underexposure ( C min < 10 mg/L) was documented in 52.7% of cases. The C min /dose after administering the loading dose was strongly associated with age ( P = 0.008), weight ( P = 0.039), and serum creatinine ( P = 0.022). The C min /dose after administering the maintenance dose was strongly associated with gender ( P = 0.014) and serum creatinine ( P = 0.006). C min ( P = 0.012) and the concomitant treatment with amphotericin B ( P = 0.001) were the independent risk factors for teicoplanin-related nephrotoxicity. Children who were concomitantly treated by amphotericin B with teicoplanin C min > 9.81 mg/L or patients with teicoplanin C min > 21.94 mg/L were at high risk for nephrotoxicity. Conclusion The fluctuations of teicoplanin C min could be affected by age, weight, gender, and serum creatinine. C min and concomitant treatment with amphotericin B were the independent risk factors for nephrotoxicity. We suggested that the therapeutic drug monitoring of teicoplanin should be performed in children.

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Section: Introductionmentioning

confidence: 99%

<p>Therapeutic Drug Monitoring and Nephrotoxicity of Teicoplanin Therapy in Chinese Children: A Retrospective Study</p>

Sun

Zhang

et al. 2020

IDR

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“…3 This glycopeptide antibiotic was used with a double purpose: as antiviral agent for COVID-19 and as empiric treatment of possible S aureus superinfection since the latter may represent a major complication of respiratory viral infections. 4,5 The study showed that only 19% (4/21 subjects) of patients treated with BAT plus tocilizumab and teicoplanin had an isolation of methicillin-resistant/teicoplanin-susceptible S aureus from respiratory secretions, and none had Grampositive superinfections. 5 Here, we reported an update of the previous data, analysing bacterial infections in a retrospective multicentric cohort study enrolling 55 mechanically ventilated, SARS-CoV-2-infected patients treated with BAT and tocilizumab (Tei-COVID Study).…”

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confidence: 99%

Superinfections in patients treated with Teicoplanin as anti‐SARS‐CoV‐2 agent

Ceccarelli

Alessandri

Oliva

et al. 2020

Eur J Clin Investigation

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We read with interest the paper by Giacobbe et al. estimating a cumulative risk of developing at least one bloodstream infection (BSI) episode (largely due to Gram‐positive pathogens) of almost 50% after 30 days at risk in severe COVID‐19 patients. (2) Similarly, Somers et al. reported an increased risk to develop bacterial superinfections, principally represented by Staphylococcus aureus ventilatory associated pneumonia (VAP), in critically ill patients infected with SARS‐CoV‐2 and treated with Tocilizumab.

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“…On the basis of a PK study of healthy volunteers, multiple-dose teicoplanin administration from 3 to 12 mg/kg of body weight showed a linear dose-serum concentration relationship [21]. However, the dose-serum concentration in critically ill patients can be highly variable [22][23][24]. Serum albumin concentrations are an important determinant of PK for antibiotics that have a high binding affinity to albumin such as teicoplanin.…”

Section: Discussionmentioning

confidence: 99%

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

Ueda

Takesue

Nakajima

et al. 2020

BMC Pharmacol Toxicol

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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.

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Evaluating the optimal dose of teicoplanin with therapeutic drug monitoring: not too high for adverse event, not too low for treatment efficacy

Cited by 33 publications

References 27 publications

<p>Therapeutic Drug Monitoring and Nephrotoxicity of Teicoplanin Therapy in Chinese Children: A Retrospective Study</p>

<p>Therapeutic Drug Monitoring and Nephrotoxicity of Teicoplanin Therapy in Chinese Children: A Retrospective Study</p>

Superinfections in patients treated with Teicoplanin as anti‐SARS‐CoV‐2 agent

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

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