Teicoplanin Dosing at 10mg/kg
Yes, teicoplanin can be dosed at 10mg/kg, particularly for severe infections, complicated bacteremia, or in settings where MRSA MIC values to glycopeptides are relatively high. 1
Recommended Dosing Regimens
Teicoplanin dosing varies based on infection severity, site of infection, and patient factors:
Standard Dosing
- Normal infections: 6-12 mg/kg/dose IV q12h for three loading doses, then once daily maintenance 1
- Severe infections: 10-12 mg/kg IV q12h for three doses, then 6-10 mg/kg once daily 1
Specific Clinical Scenarios
- High risk of MRSA infection: 6-12 mg/kg/dose IV q12h for three doses, then once daily 1
- Complicated bacteremia: 6-12 mg/kg/dose IV q12h for three to six doses, then 6-12 mg/kg/dose once daily 1
- Severe disease or deep-seated infections: Higher dose of 12 mg/kg should be considered 1
Loading Dose Considerations
A proper loading dose is crucial for achieving therapeutic levels quickly:
- For seriously ill patients: Loading dose of 25-30 mg/kg is recommended 1
- Enhanced loading regimen in renal dysfunction: 10 mg/kg twice daily on the 1st day, followed by 6.7-10 mg/kg once daily for the 2nd and 3rd days 2
Therapeutic Monitoring
- Target trough concentration (Cmin) of ≥15-30 μg/ml is recommended for optimal clinical outcomes 2
- Patients who achieve initial Cmin ≥15 μg/ml have significantly higher success rates (75.0% vs 50.0%) 2
Special Considerations
Renal Function
- Dosage adjustments are necessary in patients with renal impairment
- Even in renal dysfunction, achieving therapeutic levels (Cmin of 15-30 μg/ml) is crucial for clinical success 2
Specific Infections
- For staphylococcal endocarditis and septic arthritis: Higher doses of 12 mg/kg/day are recommended when used as monotherapy 3
- For bone infections: 10 mg/kg doses are necessary to achieve adequate bone concentrations 4
Safety Profile
At therapeutic concentrations (15-30 μg/ml):
- Nephrotoxicity occurs in approximately 13.1% of patients
- Hepatotoxicity in approximately 2.6% of patients
- These rates are not significantly higher compared to patients with lower concentrations (<15 μg/ml) 2
Clinical Pitfalls to Avoid
- Inadequate loading doses: Failure to provide adequate loading doses delays reaching therapeutic concentrations
- Ignoring MIC values: Higher doses are needed when treating organisms with higher MIC values
- Overlooking renal function: While dosage adjustment is needed in renal impairment, therapeutic levels must still be achieved
- Insufficient dosing for deep-seated infections: Bone, joint, and endocarditis infections require higher dosing regimens
In conclusion, 10mg/kg dosing of teicoplanin is appropriate and often necessary for severe infections, especially when treating deep-seated infections or when dealing with organisms with higher MIC values.