What is the recommended dosage and use of Ticoplanin (teicoplanin) for treating severe bacterial infections?

Teicoplanin Dosing and Use for Severe Bacterial Infections

For severe bacterial infections, teicoplanin should be administered with a loading dose of 12 mg/kg IV every 12 hours for three doses, followed by a maintenance dose of 6-12 mg/kg once daily, with dosing intervals adjusted based on renal function. 1

Loading Dose Strategy

• Standard infections require 6 mg/kg IV every 12 hours for three doses 2, 1
• Severe infections (endocarditis, septic arthritis, complicated bacteremia) require 12 mg/kg IV every 12 hours for three doses 2, 1
• Loading doses are critical regardless of renal function to rapidly achieve therapeutic levels 1, 3
• High-dose loading (12 mg/kg every 12 hours for 48 hours) achieves target serum concentrations ≥15 mg/L within 48 hours in critically ill patients 4

Maintenance Dosing

Standard Infections

• 6 mg/kg IV once daily after loading doses 2, 1

Severe Infections (Endocarditis, Septic Arthritis, Complicated Bacteremia)

• 12 mg/kg IV once daily after loading doses 2, 1
• Higher doses (600 mg daily in adults) achieve therapeutic levels more frequently (68% vs 37%) without increased toxicity 5

Renal Function-Based Adjustments

Maintenance dose intervals must be extended based on glomerular filtration rate (GFR): 1, 3

• GFR >50 mL/min: Every 24 hours 1, 3
• GFR 10-50 mL/min: Every 48 hours 1, 3
• GFR <10 mL/min: Every 72 hours 1, 3

Special Renal Replacement Situations

• Hemodialysis: 12 mg/kg loading, then 6 mg/kg on days 2 and 3, followed by 6 mg/kg once weekly 1, 3
• Continuous renal replacement therapy (CRRT): Follow GFR 10-50 mL/min dosing (every 48 hours) 1, 3
• CAPD peritonitis: IV dosing per GFR <10 mL/min; intraperitoneal dosing 20 mg/L in each bag for week 1, every other bag for week 2, night bag only for week 3 1, 3

Infection-Specific Recommendations

Complicated Skin and Soft Tissue Infections

• 6-12 mg/kg IV every 12 hours for three doses, then once daily for 7-14 days 2, 1

Bacteremia

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

Endocarditis

• Native valve: 12 mg/kg IV every 12 hours for three doses, then 12 mg/kg once daily for 4-6 weeks 2, 1
• Prosthetic valve: Same dosing plus rifampin 300 mg PO every 8 hours for 6 weeks 2

Osteomyelitis and Septic Arthritis

• 6-12 mg/kg IV every 12 hours for three doses, then once daily for >6 weeks (osteomyelitis) or 3-4 weeks (septic arthritis) 2, 1

Pneumonia

• 6-12 mg/kg IV every 12 hours for three doses, then once daily for 7-21 days 2, 1

Therapeutic Drug Monitoring

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

• Endocarditis or septic arthritis: Target trough ≥20 mg/L 1, 3, 6
• Standard infections: Target trough ≥10 mg/L 3, 6
• Optimal therapeutic range for most MRSA infections: 15-30 mg/L 6
• Monitor in patients with major burns, IV drug users, rapidly changing renal function, or immunocompromised status 1, 3

A meta-analysis demonstrated that trough concentrations of 15-30 mg/L significantly increased treatment success (OR 2.68) without increasing nephrotoxicity or hepatotoxicity risks 6

Critical Pitfalls to Avoid

• Inadequate loading doses lead to subtherapeutic levels regardless of subsequent dosing 1, 3, 4
• Failure to extend dosing intervals in renal impairment causes drug accumulation 3
• Using standard 6 mg/kg doses for severe infections (endocarditis, septic arthritis) results in treatment failure 2, 1
• Maximum trough concentrations ≥28 mg/L combined with serum albumin ≤1.84 g/dL are associated with organ toxicity 4
• Overlooking therapeutic drug monitoring in endocarditis or septic arthritis leads to suboptimal outcomes 1, 3

Advantages Over Vancomycin

• Long half-life allows once-daily dosing 7, 8
• Lower nephrotoxicity, especially when combined with aminoglycosides 8
• Fewer anaphylactoid reactions 8
• Can be administered intramuscularly for outpatient therapy 7, 8
• No routine serum monitoring required in uncomplicated cases 7