What is the recommended dosage of teicoplanin?

Recommended Dosage of Teicoplanin

The recommended dosage of teicoplanin for adults is a loading dose of 6-12 mg/kg given every 12 hours for three doses, followed by a maintenance dose of 6-12 mg/kg once daily, with the higher dosage range (12 mg/kg) recommended for seriously ill patients. 1

Standard Dosing Regimen

Loading Dose

• Standard loading dose: 6 mg/kg every 12 hours for three doses 1
• Higher loading dose for serious infections: 12 mg/kg every 12 hours for three doses 1
• For critically ill patients: Loading dose of 25-30 mg/kg is recommended 1

Maintenance Dose

• Standard maintenance dose: 6 mg/kg once daily (QD) 1
• For severe infections: 6-12 mg/kg once daily 1

Dosing Based on Infection Type

Skin and Soft Tissue Infections (Inpatient)

• Adults: 6-12 mg/kg/dose IV every 12 hours for three doses, then once daily 1
• Pediatric: 10 mg/kg IV every 12 hours for three doses, then 6-10 mg/kg once daily 1

Bacteremia

• Uncomplicated: 6-12 mg/kg/dose IV every 12 hours for three doses, then once daily 1
• Complicated: 6-12 mg/kg/dose IV every 12 hours for three to six doses, then 6-12 mg/kg/dose once daily 1

Pneumonia (MRSA coverage)

• 6-12 mg/kg/dose IV every 12 hours for three doses, then 6-12 mg/kg/dose once daily 1

Septic Arthritis

• 6-12 mg/kg/dose IV every 12 hours for three doses, then once daily for 3-4 weeks 1

Osteomyelitis

• 6-12 mg/kg/dose IV every 12 hours for three doses, then once daily for >6 weeks 1

Fournier's Gangrene (Unstable patients)

• Loading dose 12 mg/kg every 12 hours for 3 doses, then 6 mg/kg every 12 hours 1

Dosing Considerations

Renal Function

Dose adjustment is necessary based on renal function:

• GFR > 90 mL/min: Every 24 hours
• GFR 50-90 mL/min: Every 24 hours
• GFR 10-50 mL/min: Every 48 hours
• GFR < 10 mL/min: Every 72 hours 2

Target Plasma Concentrations

• For most infections: Trough levels ≥10 mg/L 3
• For severe infections (endocarditis, septic arthritis): Trough levels close to 20 mg/L 4, 5

Practical Considerations

Achieving Therapeutic Levels

• A loading dose of 12 mg/kg results in faster attainment of therapeutic trough plasma concentrations (≥10 mg/L) compared to 6 mg/kg 3
• With a 12 mg/kg loading dose, 90% of patients achieve therapeutic levels by day 2, compared to only 18.2% with a 6 mg/kg loading dose 3

Monitoring

• Unlike vancomycin, routine drug monitoring is not required for safety reasons 6
• Consider monitoring in specific situations:
  • Treatment of endocarditis or septic arthritis
  • Patients with major burns
  • Intravenous drug users
  • Rapidly changing renal function 2

Administration

• Can be administered intravenously or intramuscularly 6
• For IV administration, administer as a bolus injection or infusion

Special Populations

Neutropenic Patients with Acute Leukemia

Higher dosing may be beneficial:

• Loading: 12 mg/kg and 6 mg/kg 12 hours apart on day 1, followed by 9 mg/kg and 6 mg/kg 12 hours apart on day 2
• Maintenance: 6 mg/kg every 12 hours may help ensure trough concentrations close to 20 mg/L 4

Cardiac Surgery Prophylaxis

• Loading dose of 12 mg/kg given three times on the first day
• Maintenance dose of 6 mg/kg every 24 hours based on renal function 2

By following these dosing recommendations, therapeutic levels of teicoplanin can be achieved efficiently, leading to improved clinical outcomes in patients with gram-positive infections.