Recommended Dosage of Teicoplanin for Adults
The standard teicoplanin dosing regimen for adults consists of a loading dose of 6 mg/kg (or 12 mg/kg for severe infections) administered 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
Standard Dosing Protocol
- Initial loading dose: 6 mg/kg every 12 hours for three doses to rapidly achieve therapeutic levels 1, 2
- Higher loading dose for severe infections: 12 mg/kg every 12 hours for three doses (particularly for S. aureus endocarditis or septic arthritis) 1, 2
- Standard maintenance dose: 6 mg/kg once daily for standard infections 1, 3
- Higher maintenance dose for severe infections: 12 mg/kg once daily (for S. aureus endocarditis or septic arthritis) 1, 2
Dose Adjustments Based on Renal Function
- Normal renal function (GFR > 90 mL/min): Administer every 24 hours 1, 4
- Moderate renal impairment (GFR 50-90 mL/min): Administer every 24 hours 1, 4
- Severe renal impairment (GFR 10-50 mL/min): Administer every 48 hours 1, 4
- End-stage renal disease (GFR < 10 mL/min): Administer every 72 hours 1, 4
Special Clinical Situations
- Hemodialysis patients: Loading dose of 12 mg/kg, followed by 6 mg/kg on days 2 and 3, and maintenance of 6 mg/kg once weekly 1, 4
- CAPD peritonitis: IV dosing follows GFR < 10 mL/min recommendations; intraperitoneal dosing is 20 mg/L in each bag for the first week, 20 mg/kg every other bag for the second week, and 20 mg/kg in the night bag only for the third week 1, 4
- Continuous renal replacement therapy: Follow dosing for GFR 10-50 mL/min 4
Target Serum Concentrations and Monitoring
- For standard infections: Target trough concentration ≥10 mg/L 4, 5
- For severe infections (endocarditis, septic arthritis, osteomyelitis): Target trough concentration ≥20 mg/L 4, 2
- Therapeutic drug monitoring is not routinely required but is indicated in specific situations such as S. aureus endocarditis, septic arthritis, patients with major burns, intravenous drug users, and those with rapidly changing renal function 1, 4
Infection-Specific Treatment Duration
- Complicated skin and soft tissue infections: 7-14 days 1
- Bacteremia (uncomplicated): 2 weeks 1
- Bacteremia (complicated): 4-6 weeks 1
- Osteomyelitis: >6 weeks 1
- Septic arthritis: 3-4 weeks 1
Common Pitfalls to Avoid
- Inadequate loading doses can lead to subtherapeutic levels, regardless of renal function 4, 6
- Failure to extend dosing intervals in renal impairment can cause drug accumulation 4
- Standard 400 mg daily dosing often results in subtherapeutic levels; studies suggest 600 mg daily may be more effective in achieving therapeutic levels without increasing toxicity 7
- Patients with acute leukemia and febrile neutropenia may require higher doses (12 mg/kg and 6 mg/kg 12 hours apart on day 1,9 mg/kg and 6 mg/kg 12 hours apart on day 2) to achieve therapeutic levels 6