What is the recommended dose of Ticoplanin (teicoplanin) for patients with impaired renal function?

Teicoplanin Dosing in Patients with Impaired Renal Function

For patients with impaired renal function, teicoplanin requires a standard loading dose of 6-12 mg/kg three times (regardless of renal function), followed by maintenance doses adjusted according to glomerular filtration rate (GFR), with dosing intervals extended to 48 hours for GFR 10-50 mL/min and 72 hours for GFR <10 mL/min. 1

Dosing Algorithm Based on Renal Function

Loading Dose

• Initial loading dose remains the same regardless of renal function: 6 mg/kg three times (or 12 mg/kg three times for severe infections like endocarditis or septic arthritis) 1
• Loading doses are critical to rapidly achieve therapeutic levels and are not affected by alterations in renal function 1

Maintenance Dose and Interval Based on GFR

• GFR >90 mL/min: 6-12 mg/kg every 24 hours 1
• GFR 50-90 mL/min: 6-12 mg/kg every 24 hours 1
• GFR 10-50 mL/min: 6-12 mg/kg every 48 hours 1
• GFR <10 mL/min: 6-12 mg/kg every 72 hours 1

Special Populations

Hemodialysis Patients

• Loading dose: 12 mg/kg 1
• Day 2 and 3: 6 mg/kg each day 1
• Maintenance: 6 mg/kg once weekly 1

CAPD Peritonitis

• Intravenous dosing: Follow dosing for GFR <10 mL/min 1
• Intraperitoneal dosing: 1
  • First week: 20 mg/L in each bag
  • Second week: 20 mg/kg every other bag
  • Third week: 20 mg/kg in the night bag only

CAVH(D)-CVVH(D)

• Follow dosing recommendations for GFR 10-50 mL/min 1

Therapeutic Drug Monitoring

• Unlike vancomycin, routine monitoring of teicoplanin levels is not generally recommended by manufacturers 1
• However, monitoring is indicated in specific situations: 1
  • S. aureus endocarditis or septic arthritis (target trough ≥20 mg/L)
  • Patients with major burns
  • Intravenous drug users
  • Patients with rapidly changing renal function
  • Immunocompromised patients 2

Higher Dosing Considerations

• For severe infections like endocarditis or septic arthritis, higher doses (12 mg/kg) are recommended to achieve trough concentrations of at least 20 mg/L 1, 3
• Studies suggest that higher maintenance doses (600 mg daily in adults with normal renal function) achieve therapeutic levels more frequently (68% vs 37%) without increased toxicity compared to standard 400 mg dosing 4
• In patients with normal renal function but increased volume of distribution (e.g., critically ill patients), loading doses are particularly important to rapidly achieve therapeutic levels 1

Common Pitfalls to Avoid

• Failure to provide adequate loading doses, which are essential regardless of renal function 1, 5
• Not extending dosing intervals appropriately in renal impairment, which can lead to drug accumulation 1, 6
• Overlooking the need for therapeutic drug monitoring in high-risk situations or specific infections 1
• Using standard doses in severe infections like endocarditis, where higher doses are needed for optimal outcomes 3

Target Trough Concentrations

• Standard infections: ≥10 mg/L 1, 6
• Severe infections (endocarditis, septic arthritis): ≥20 mg/L 1, 3