What is the recommended dose of Teicoplanin for treatment?

Recommended Teicoplanin Dosing Regimen

For standard treatment of infections, teicoplanin should be administered with a loading dose of 6 mg/kg (or 12 mg/kg for severe infections) three times at 12-hour intervals, followed by a maintenance dose of 6 mg/kg (or 12 mg/kg for severe infections) once daily, with dose adjustments based on renal function. 1

General Dosing Guidelines

Standard Loading and Maintenance Doses

• Initial loading: 6 mg/kg every 12 hours for three doses 1
• Higher loading for severe infections: 12 mg/kg every 12 hours for three doses (S. aureus endocarditis or septic arthritis) 1
• Maintenance: 6 mg/kg once daily (standard infections) 1
• Higher maintenance for severe infections: 12 mg/kg once daily (S. aureus endocarditis or septic arthritis) 1

Dose Adjustment Based on Renal Function

• Normal renal function (GFR > 90 mL/min): Dose every 24 hours 1
• Moderate renal impairment (GFR 50-90 mL/min): Dose every 24 hours 1
• Severe renal impairment (GFR 10-50 mL/min): Dose every 48 hours 1
• End-stage renal disease (GFR < 10 mL/min): Dose every 72 hours 1

Special Clinical Situations

Hemodialysis Patients

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

CAPD Peritonitis

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

Continuous Renal Replacement Therapy

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

Pediatric Patients

• Loading: Three doses of 10 mg/kg every 12 hours 1
• Maintenance: 6-10 mg/kg every 24 hours 1
• Not recommended for neonates 1

Therapeutic Drug Monitoring

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

Common Pitfalls and Caveats

• Inadequate loading doses often lead to subtherapeutic levels; ensure proper loading regimen is followed 2, 3
• Standard 400 mg daily maintenance doses frequently result in subtherapeutic levels; 600 mg daily may be more appropriate for many adult patients 3
• Higher doses (600 mg daily) achieve therapeutic levels more frequently without increased toxicity 3
• For severe infections, higher doses are crucial to rapidly achieve therapeutic concentrations 2
• Loading doses are essential due to teicoplanin's long half-life (157 hours) 4
• The once-daily maintenance dosing is possible due to teicoplanin's favorable pharmacokinetic profile 5, 6

Infection-Specific Recommendations

Complicated Skin and Soft Tissue Infections

• Adults: 6-12 mg/kg IV q12h for three doses, then once daily 1
• Duration: 7-14 days 1

Bacteremia

• Uncomplicated: 6-12 mg/kg IV q12h for three doses, then once daily 1
• Complicated: 6-12 mg/kg IV q12h for three to six doses, then 6-12 mg/kg once daily 1
• Duration: 2 weeks for uncomplicated, 4-6 weeks for complicated 1

Osteomyelitis and Septic Arthritis

• 6-12 mg/kg IV q12h for three doses, then once daily 1
• Duration: >6 weeks for osteomyelitis, 3-4 weeks for septic arthritis 1