Can a combination with teicoplanin be considered for a patient with sepsis?

From the Guidelines

Teicoplanin can be considered as part of combination therapy for patients with sepsis, particularly when Gram-positive bacterial infections are suspected or confirmed. It is often combined with antibiotics that target Gram-negative organisms, such as piperacillin-tazobactam, carbapenems, or third/fourth generation cephalosporins, to provide broad-spectrum coverage until culture results are available. The typical adult dosing for teicoplanin in sepsis is a loading dose of 6-12 mg/kg (usually 400-800 mg) every 12 hours for 3 doses, followed by 6-12 mg/kg once daily, with adjustments based on renal function 1. Teicoplanin is a glycopeptide antibiotic similar to vancomycin but with some advantages including once-daily dosing, less nephrotoxicity, and fewer infusion-related reactions. It is effective against methicillin-resistant Staphylococcus aureus (MRSA), Streptococcus species, and Enterococcus species. However, local antibiotic resistance patterns, patient factors (allergies, renal function), and institutional protocols should guide the final choice of antimicrobial therapy. Blood levels should be monitored in severe infections to ensure adequate therapeutic concentrations, with trough levels ideally above 15-20 mg/L for serious infections like sepsis 1. Some key points to consider when using teicoplanin in sepsis include:

• The need for a loading dose to rapidly achieve therapeutic levels, especially in critically ill patients with sepsis or septic shock 1
• The importance of monitoring renal function and adjusting the dose accordingly 1
• The potential for teicoplanin to be used in combination with other antibiotics to provide broad-spectrum coverage 1
• The need to consider local antibiotic resistance patterns and patient factors when selecting antimicrobial therapy 1

From the Research

Combination Therapy with Teicoplanin for Sepsis

• Teicoplanin has been used in combination with other antimicrobials for the treatment of serious infections, including sepsis 2, 3.
• A study comparing linezolid with teicoplanin for the treatment of Gram-positive infections in critically ill patients found that both antibiotics had similar clinical and microbiological success rates 4.
• However, linezolid was superior at initial clearance of methicillin-resistant Staphylococcus aureus (MRSA) colonization 4.
• Teicoplanin has been shown to be effective in combination with other antimicrobials for the treatment of sepsis, including endocarditis and bacteremia 2, 3.

Pharmacokinetics and Dosage Regimens

• A population pharmacokinetic analysis of teicoplanin in adult septic patients found that a two-compartment model adequately described the data 5.
• The study recommended a loading dose of 12-15 mg/kg every 12 hours, followed by a maintenance dose of 12-15 mg/kg every 24-72 hours, depending on renal function 5.
• Another study developed a UPLC-MS/MS method for simultaneous determination of eight special-grade antimicrobials, including teicoplanin, in human plasma 6.

Efficacy and Safety

• Teicoplanin has been shown to be effective and safe in the treatment of Gram-positive infections, including sepsis 2, 3, 4.
• The antibiotic has a long half-life, allowing for once-daily administration, and has been associated with fewer adverse effects compared to vancomycin 2, 3.
• However, teicoplanin may not be as effective as other antibiotics, such as linezolid, in clearing MRSA colonization 4.