What is the recommended dose of Teicoplanin?

Teicoplanin Dosing Recommendations

For standard infections, administer teicoplanin with a loading dose of 6 mg/kg every 12 hours for three doses, followed by 6 mg/kg once daily maintenance; for severe infections including endocarditis and septic arthritis, use 12 mg/kg every 12 hours for three doses, followed by 12 mg/kg once daily maintenance. 1, 2

Standard Dosing Algorithm

Loading Dose Phase

• Standard infections: 6 mg/kg IV every 12 hours for 3 doses (total 18 mg/kg over 36 hours) 1, 3
• Severe infections (endocarditis, septic arthritis, complicated bacteremia): 12 mg/kg IV every 12 hours for 3 doses (total 36 mg/kg over 36 hours) 1, 2, 4
• Loading doses remain the same regardless of renal function and are critical to rapidly achieve therapeutic levels 3

Maintenance Dose Phase

For patients with normal renal function (GFR >90 mL/min):

• Standard infections: 6 mg/kg once daily 1, 3
• Severe infections: 12 mg/kg once daily 1, 2

For patients with moderate renal impairment (GFR 50-90 mL/min):

• Administer 6-12 mg/kg every 24 hours 1, 3

For patients with severe renal impairment (GFR 10-50 mL/min):

• Administer 6-12 mg/kg every 48 hours 1, 3

For patients with end-stage renal disease (GFR <10 mL/min):

• Administer 6-12 mg/kg every 72 hours 1, 3

Infection-Specific Dosing

Complicated Skin and Soft Tissue Infections

• 6-12 mg/kg IV every 12 hours for 3 doses, then once daily 1
• Duration: 7-14 days 1
• For Fournier's gangrene specifically: Loading dose 12 mg/kg every 12 hours for 3 doses, then 6 mg/kg every 12 hours as part of combination therapy 5

Bacteremia

• Uncomplicated: 6-12 mg/kg IV every 12 hours for 3 doses, then once daily for 2 weeks 1
• Complicated: 6-12 mg/kg IV every 12 hours for 3-6 doses, then 6-12 mg/kg once daily for 4-6 weeks 1, 2

Endocarditis and Septic Arthritis

• Critical dosing: 12 mg/kg every 12 hours for 3 doses, then 12 mg/kg once daily 1, 2, 4
• Duration: 3-4 weeks for septic arthritis, longer for endocarditis 1
• Target trough concentration ≥20 mg/L 1, 2

Osteomyelitis

• 6-12 mg/kg IV every 12 hours for 3 doses, then once daily 1
• Duration: >6 weeks 1

Special Populations

Hemodialysis Patients

• Loading dose: 12 mg/kg 1, 3
• Days 2 and 3: 6 mg/kg 1, 3
• Maintenance: 6 mg/kg once weekly 1, 3

CAPD Peritonitis

• IV dosing: Follow GFR <10 mL/min recommendations 1, 3
• Intraperitoneal dosing:
  • Week 1: 20 mg/L in each bag 1, 3
  • Week 2: 20 mg/kg every other bag 1, 3
  • Week 3: 20 mg/kg in night bag only 1, 3

Continuous Renal Replacement Therapy

• Follow GFR 10-50 mL/min recommendations (every 48 hours) 1, 3

Pediatric Patients

• Loading dose: 10 mg/kg every 12 hours for 3 doses 1
• Maintenance: 6-10 mg/kg every 24 hours 1

Therapeutic Drug Monitoring

Routine monitoring is not generally required but is indicated in specific situations: 1, 3

• S. aureus endocarditis or septic arthritis (target trough ≥20 mg/L) 1, 2
• Major burns 1, 3
• Intravenous drug users 1, 3
• Rapidly changing renal function 1, 3
• Immunocompromised patients 3

Target trough concentrations:

• Standard infections: ≥10 mg/L 3
• Severe infections (endocarditis, septic arthritis): ≥20 mg/L 1, 3, 2

Common Pitfalls to Avoid

• Inadequate loading doses: Failure to provide adequate loading doses leads to subtherapeutic levels regardless of renal function 3
• Underdosing severe infections: Using 6 mg/kg instead of 12 mg/kg for endocarditis or septic arthritis results in treatment failure 4, 6
• Incorrect interval adjustment: Not extending dosing intervals appropriately in renal impairment causes drug accumulation 3
• Overlooking monitoring needs: Missing the need for therapeutic drug monitoring in high-risk situations leads to suboptimal outcomes 1, 3

Evidence Quality Considerations

The higher dosing regimen (12 mg/kg) for severe infections is supported by multiple studies showing that standard 400 mg (approximately 6 mg/kg) daily doses frequently result in subtherapeutic levels 7. Research demonstrates that 600 mg daily doses (approximately 12 mg/kg for a 50 kg patient) achieve therapeutic levels in 68% versus 37% with lower doses, without increased toxicity 7. For endocarditis specifically, trough levels over 20 mg/L are needed for cure rates similar to vancomycin 4, 6.