Optimal Trough Concentration of Teicoplanin in Febrile Neutropenic Patients with Hematological Malignancy

Abstract

Background: Teicoplanin is a glycopeptide antibiotic currently used for the treatment of methicillin-resistant Staphylococcus aureus. The need for therapeutic drug monitoring of teicoplanin has been increasingly highlighted as important. It is generally accepted that whereas a plasma trough concentration (C_min) of ≥10 mg/L is appropriate for the majority of infections, it should exceed 20 mg/L for severe infections. The target C_min of teicoplanin in patients with febrile neutropenia (FN) has not been reported. The aim of this study was to estimate the target C_min for the treatment of FN in patients with hematological malignancy. Methods: In this retrospective, single-center, observational cohort study, the records of 52 hospitalized patients with hematological malignancy who were treated with teicoplanin for FN due to bacteriologically documented or presumptive gram-positive infections were analyzed. Results: A significant difference in the first C_min of teicoplanin was observed between the response and nonresponse groups in patients with bacteremia. The areas under the receiver operating characteristic curves were 0.80 for clinical efficacy. The cut-off value of teicoplanin C_min on days 4-6 was 15.2 mg/L (sensitivity 80.0%, specificity 75.0%). Conclusions: The authors propose a target teicoplanin C_min of ≥15.2 mg/L for FN in patients with hematological malignancy.

Comparative efficacy and safety of vancomycin versus teicoplanin in febrile neutropenic patients receiving hematopoietic stem cell transplantation

“…Third, the initial dose of teicoplanin was determined so as to attain a target trough concentration of 10‐30 μg/mL. However, for febrile neutropenic patients with bacteremia, the teicoplanin target C min is reported to at least ≥15.2 μg/mL or 15‐20 μg/mL . Many studies have suggested that the standard regimen for teicoplanin does not meet the desired C min for haematological malignancy patients with febrile neutropenia.…”

Accuracy of Therapeutic Drug Monitoring of Teicoplanin at the Onset of Febrile Neutropenia

“…One mechanism of increased clearance due to FN is thought to be augmented renal clearance due to inflammation [14]. To solve this problem, studies have been conducted on the pharmacokinetic parameters specific to patients with cancer [10] and on the optimization of TEIC dosing and blood concentration in patients with hematologic malignancies who develop FN [15][16][17].…”

Therapeutic Drug Monitoring of Teicoplanin in Haematological Malignancy Patients with Febrile Neutropenia and Optimizing Dosage Regimens

“…Teicoplanin and vancomycin are glycopeptide antibacterials that inhibit bacterial cell-wall peptidoglycan synthesis and are the first-line treatment for drug-resistant Gram-positive bacteria [1]. Both of them are effective in febrile neutropenic patients [7], and compared with vancomycin, teicoplanin has advantages of comparable antibacterial activity, post-antibiotic effect and lower frequency of nephrotoxicity or red-man syndrome [8,9], and so teicoplanin can be used as an initial empirical choice for febrile neutropenic patients with haematological malignancies [10]. Ziglam et al [11] showed that teicoplanin was chosen approximately twice as often as vancomycin for the second-line antimicrobials when empirical therapy did not respond after 24-48 hr for febrile neutropenic patients in oncology units.…”

“…Maintaining the C min of teicoplanin above 10 mg/L can effectively control general infections . For febrile neutropenic patients with bacteraemia, the teicoplanin C min must be at least ≥15.2 mg/L or 15–20 mg/L . For endocarditis, septicaemia and bone or joint infections, the C min of teicoplanin should exceed 20 mg/L in immunosuppressed patient .…”

“…For febrile neutropenic patients with bacteraemia, the teicoplanin C min must be at least ≥15.2 mg/L or 15–20 mg/L . For endocarditis, septicaemia and bone or joint infections, the C min of teicoplanin should exceed 20 mg/L in immunosuppressed patient . The current common dosage regimen first applies teicoplanin at 400 mg q12h for three doses as a loading dosage, followed by 400 mg qd as a maintenance dosage in Chinese instructions, and teicoplanin C min higher than 10 mg/L is recommended.…”