What is the recommended dose of Teicoplanin (glycopeptide antibiotic) for treatment?

Teicoplanin Dosing Recommendations

The recommended dosing regimen for teicoplanin is a loading dose of 6-12 mg/kg three times (administered at 12-hour intervals for the first two doses and 24 hours after the third dose), followed by a maintenance dose of 6-12 mg/kg daily, adjusted according to renal function. 1

Standard Dosing Protocol

Loading Dose

• Initial loading dose is essential regardless of renal function to rapidly achieve therapeutic levels 1, 2
• Standard loading: 6 mg/kg every 12 hours for three doses 3
• For severe infections (endocarditis, septic arthritis): 12 mg/kg every 12 hours for three doses 3, 1

Maintenance Dose

• Normal infections: 6 mg/kg daily 3
• Severe infections (endocarditis, septic arthritis): 12 mg/kg daily 3, 1, 4

Dose Adjustment Based on Renal Function

Maintenance Dose Intervals

• GFR >90 mL/min: 6-12 mg/kg every 24 hours 3, 1
• GFR 50-90 mL/min: 6-12 mg/kg every 24 hours 3, 1
• GFR 10-50 mL/min: 6-12 mg/kg every 48 hours 3, 1
• GFR <10 mL/min: 6-12 mg/kg every 72 hours 3, 1

Special Populations

Hemodialysis Patients

• Loading dose: 12 mg/kg 3, 1
• Follow with 6 mg/kg on days 2 and 3 3, 1
• Maintenance: 6 mg/kg once weekly 3, 1

CAPD Peritonitis

• Intravenous dosing: Follow GFR <10 mL/min guidelines 3
• Intraperitoneal dosing: 20 mg/L in each bag (1st week), 20 mg/kg every other bag (2nd week), 20 mg/kg in night bag only (3rd week) 3

Pediatric Dosing

• 10 mg/kg IV every 12 hours for three doses, then 6-10 mg/kg daily 3

Therapeutic Drug Monitoring

• Target trough concentrations:

  • Standard infections: ≥10 mg/L 1, 5, 2
  • Severe infections (endocarditis, septic arthritis): ≥20 mg/L 1, 4

• Monitoring is indicated in:

  • S. aureus endocarditis or septic arthritis 3, 1
  • Major burns 3, 1
  • Intravenous drug users 3, 1
  • Patients with rapidly changing renal function 3, 1
  • Immunocompromised patients 1

Clinical Considerations

• Higher loading doses (12 mg/kg) achieve therapeutic concentrations more rapidly than standard doses (6 mg/kg) 5
• A 600 mg daily maintenance dose (rather than 400 mg) achieves therapeutic levels more frequently (68% vs. 37%) without increased toxicity in patients with normal renal function 6
• Failure to provide adequate loading doses leads to subtherapeutic levels for several days, potentially compromising treatment efficacy 2
• For complicated bacteremia, teicoplanin should be administered at 6-12 mg/kg/dose IV every 12 hours for three to six doses, then 6-12 mg/kg/dose daily 3

Common Pitfalls to Avoid

• Omitting loading doses, which delays achieving therapeutic concentrations 1, 2
• Not adjusting dosing intervals in renal impairment, leading to drug accumulation 1
• Failing to monitor drug levels in high-risk situations 3, 1
• Using monotherapy with standard dosing for severe infections like endocarditis 4