What is the recommended Targocid (Teicoplanin) dosing regimen?

Targocid (Teicoplanin) Dosing Regimen

For adults with serious MRSA infections, administer teicoplanin with a loading dose of 6-12 mg/kg IV every 12 hours for 3 doses, followed by a maintenance dose of 6-12 mg/kg IV once daily, with higher doses (10-12 mg/kg) required for complicated infections such as endocarditis, osteomyelitis, and septic arthritis. 1

Adult Dosing by Indication

Standard Infections (Skin/Soft Tissue, Uncomplicated Bacteremia)

• Loading regimen: 6-12 mg/kg IV every 12 hours for 3 doses 1
• Maintenance: 6-12 mg/kg IV once daily 1
• Duration: 7-14 days for skin/soft tissue infections; 2 weeks for uncomplicated bacteremia 1

Complicated/Severe Infections

Complicated Bacteremia:

• Loading: 6-12 mg/kg IV every 12 hours for 3-6 doses 1
• Maintenance: 6-12 mg/kg IV once daily 1
• Duration: 4-6 weeks 1

Pneumonia:

• Loading: 6-12 mg/kg IV every 12 hours for 3 doses 1
• Maintenance: 6-12 mg/kg IV once daily 1
• Duration: 7-21 days 1

Osteomyelitis/Septic Arthritis:

• Loading: 6-12 mg/kg IV every 12 hours for 3 doses 1
• Maintenance: 6-12 mg/kg IV once daily 1
• Duration: >6 weeks for osteomyelitis; 3-4 weeks for septic arthritis 1
• Note: Higher doses (12 mg/kg daily) are specifically recommended for septic arthritis 2

Endocarditis:

• Loading: 6-12 mg/kg IV every 12 hours for 3 doses 1
• Maintenance: 6-12 mg/kg IV once daily 1
• Duration: 4-6 weeks for native valve; 6 weeks for prosthetic valve 1
• Critical consideration: Monotherapy requires 12 mg/kg daily to achieve cure rates similar to vancomycin, with target trough levels >20 mg/L 2

Pediatric Dosing

• Loading dose: 10 mg/kg IV every 12 hours for 3 doses 1
• Maintenance: 6-10 mg/kg IV once daily 1
• Maximum loading dose: 400 mg per dose 1

Loading Dose Rationale

A loading dose of 25-30 mg/kg (based on actual body weight) is warranted in critically ill patients to rapidly achieve therapeutic drug levels due to expanded extracellular volume from fluid resuscitation. 1 This principle applies to teicoplanin, which has a low volume of distribution similar to vancomycin 1. The standard 3-dose loading regimen (6-12 mg/kg every 12 hours) addresses the drug's slow accumulation to steady state, which would otherwise take 14 days 3.

Therapeutic Drug Monitoring

• Target trough levels: 10-20 mg/L for most infections 3
• Severe infections (endocarditis, osteomyelitis): Target trough >20 mg/L 2
• Timing: Check trough before 4th or 5th dose 3
• Note: Recent evidence suggests 600 mg daily (approximately 8-10 mg/kg for 60-75 kg adults) achieves therapeutic levels in 68% of patients versus 37% with 400 mg daily, without increased toxicity 4

Renal Dosing Adjustments

• Loading dose: No adjustment required regardless of renal function 1
• Maintenance dose: Reduce frequency based on creatinine clearance 5
• Hemodialysis patients: 6 mg/kg every 12 hours for 3 loading doses, then maintenance every 72 hours 3
• Negligible drug removal during hemodialysis 5

Common Pitfalls

Underdosing is the most common error with teicoplanin. Early trials using 200-400 mg daily showed poor results, particularly in endocarditis 2. The standard 6 mg/kg daily dose is inadequate for deep-seated staphylococcal infections when used as monotherapy 2. For complicated infections, do not hesitate to use 10-12 mg/kg daily or combination therapy with aminoglycosides 2.

Do not skip the loading regimen. Without loading doses, therapeutic concentrations are delayed due to the drug's 83-168 hour terminal half-life 3. The 3-dose loading regimen is essential for rapid therapeutic effect 3.