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

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; for severe infections including endocarditis and septic arthritis, use 12 mg/kg every 12 hours for three doses, then 12 mg/kg once daily. 1, 2

Standard Dosing Algorithm

Loading Dose Phase

• Standard infections: 6 mg/kg IV every 12 hours for three doses (total of three doses over 48 hours) 3, 1
• Severe infections (endocarditis, septic arthritis, osteomyelitis): 12 mg/kg IV every 12 hours for three doses 3, 1, 2
• The loading dose is critical and must not be skipped, as teicoplanin requires this to rapidly achieve therapeutic levels 1, 4

Maintenance Dose Phase

• Standard infections: 6 mg/kg once daily 3, 1
• Severe infections: 12 mg/kg once daily to achieve target trough concentrations ≥20 mg/L 3, 2, 5

Renal Function-Based Dosing Intervals

After the loading phase, adjust the dosing interval based on glomerular filtration rate (GFR):

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

Critical pitfall: The loading dose remains the same regardless of renal function—only the maintenance interval changes. 6

Special Clinical Situations

Hemodialysis Patients

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

CAPD Peritonitis

• Intravenous route: Follow GFR <10 mL/min dosing (every 72 hours) 3, 6
• Intraperitoneal route:
  • Week 1: 20 mg/L in each bag 3, 6
  • Week 2: 20 mg/kg every other bag 3, 6
  • Week 3: 20 mg/kg in night bag only 3, 6

Continuous Renal Replacement Therapy (CAVH/CVVH)

• Follow dosing for GFR 10-50 mL/min (every 48 hours) 3, 6

Pediatric Dosing

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

Therapeutic Drug Monitoring

Routine monitoring is not required by the manufacturer, but specific situations mandate level checks: 3, 7

When to Monitor

• S. aureus endocarditis or septic arthritis 3, 2
• Major burns 3, 6
• Intravenous drug users 3, 6
• Rapidly changing renal function 3, 6
• Combination therapy with aminoglycosides 3

Target Trough Concentrations

• Standard infections: ≥10 mg/L 6, 4
• Severe infections (endocarditis, septic arthritis): ≥20 mg/L 3, 2, 5

Evidence Quality Discussion

The most recent guidelines 1, 6, 2 consistently recommend the 6 mg/kg loading dose for standard infections and 12 mg/kg for severe infections. Research evidence supports that higher loading doses (12 mg/kg) achieve therapeutic levels more rapidly—90-100% of patients reached target concentrations by days 2-3 with 12 mg/kg versus only 16-18% with 6 mg/kg. 4

For endocarditis specifically, older trials demonstrated that 6 mg/kg monotherapy had suboptimal cure rates, but 12 mg/kg or combination therapy with aminoglycosides achieved comparable efficacy to vancomycin. 5, 8 A 2014 study showed that 600 mg daily (approximately 8-10 mg/kg for average adults) achieved therapeutic levels in 68% of patients without increased toxicity. 9

Common Pitfalls to Avoid

• Inadequate loading: Failing to give three loading doses leads to delayed therapeutic levels regardless of renal function 6, 4
• Underdosing severe infections: Using 6 mg/kg for endocarditis or septic arthritis when 12 mg/kg is required 3, 5
• Incorrect interval adjustment: Not extending dosing intervals in renal impairment causes drug accumulation 6
• Overlooking monitoring needs: Missing the need for therapeutic drug monitoring in high-risk situations leads to treatment failure 3, 2