What is the recommended dose of Teicoplanin?

Teicoplanin Dosing Recommendations

For standard infections, administer a loading dose of 6 mg/kg IV every 12 hours for three doses, followed by 6 mg/kg IV once daily; for severe infections (endocarditis, septic arthritis, osteomyelitis), use 12 mg/kg IV every 12 hours for three doses, followed by 12 mg/kg IV once daily, with dosing intervals extended based on renal function. 1, 2

Loading Dose Strategy

The loading dose is critical and must be given at full dose regardless of renal function, as it depends on volume of distribution rather than clearance. 1, 2

• Standard infections: 6 mg/kg IV every 12 hours for three doses 1, 2
• Severe infections (S. aureus endocarditis, septic arthritis, osteomyelitis, bacteremia): 12 mg/kg IV every 12 hours for three doses 1, 2, 3
• In critically ill patients with expanded extracellular volume from fluid resuscitation, aggressive loading is essential to rapidly achieve therapeutic levels 1
• Failure to provide adequate loading doses leads to subtherapeutic levels regardless of renal function 1

Maintenance Dosing Based on Renal Function

After completing the loading regimen, adjust maintenance dosing according to GFR:

• GFR >50 mL/min: 6-12 mg/kg every 24 hours 1, 2
• GFR 10-50 mL/min: 6-12 mg/kg every 48 hours 1, 2
• GFR <10 mL/min: 6-12 mg/kg every 72 hours 1, 2

The dose per kilogram remains the same; only the interval changes with renal impairment. 1

Infection-Specific Dosing

Severe Infections Requiring Higher Doses (12 mg/kg)

• Endocarditis: 12 mg/kg every 12 hours for three doses, then 12 mg/kg once daily for 4-6 weeks 2, 3
• Septic arthritis: 12 mg/kg every 12 hours for three doses, then 12 mg/kg once daily for 3-4 weeks 2, 3
• Osteomyelitis: 12 mg/kg every 12 hours for three doses, then 12 mg/kg once daily for >6 weeks 2, 3
• Complicated bacteremia: 12 mg/kg every 12 hours for three to six doses, then 12 mg/kg once daily for 4-6 weeks 2

Standard Infections (6 mg/kg)

• Uncomplicated bacteremia: 6 mg/kg every 12 hours for three doses, then 6 mg/kg once daily for 2 weeks 2
• Complicated skin and soft tissue infections: 6 mg/kg every 12 hours for three doses, then 6 mg/kg once daily for 7-14 days 2

Special Populations

Hemodialysis Patients

• Loading dose: 12 mg/kg, followed by 6 mg/kg on days 2 and 3 1, 2
• Maintenance: 6 mg/kg once weekly 1, 2

CAPD Peritonitis

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

Continuous Renal Replacement Therapy (CVVH/CAVH)

• Follow dosing recommendations for GFR 10-50 mL/min (every 48 hours) 1, 2

Pediatric Patients

• Loading dose: 10 mg/kg IV every 12 hours for three doses 4
• Maintenance dose: 6-10 mg/kg IV every 24 hours (adjust intervals for renal impairment as in adults) 4
• For severe infections, consider 12 mg/kg loading doses and 10-12 mg/kg maintenance 4

Therapeutic Drug Monitoring

Routine monitoring is not required for most patients, but is mandatory in specific high-risk situations: 1, 2

• S. aureus endocarditis or septic arthritis 1, 2
• Major burns 1, 2
• Intravenous drug users 1, 2
• Rapidly changing renal function 1, 2
• Immunocompromised patients 1, 2
• Pediatric patients (due to highly variable pharmacokinetics) 4

Target Trough Concentrations

• Standard infections: ≥10 mg/L 1, 2
• Severe infections (endocarditis, septic arthritis, bacteremia): ≥20 mg/L 1, 2, 3
• Therapeutic window: 15-30 mg/L for most infections 1
• Potentially toxic levels: >60 mg/L 1, 5

Practical Considerations for Optimal Dosing

In stable adult patients with normal renal function, a 600 mg twice daily loading regimen (two doses) followed by 600 mg daily maintenance achieves therapeutic levels more frequently (68% vs 37%) without increasing toxic levels, compared to the traditional 400 mg daily dosing. 5

Common Pitfalls to Avoid

• Never reduce loading doses for renal impairment—this leads to delayed therapeutic levels 1
• Do not overlook the need for higher doses (12 mg/kg) in endocarditis and septic arthritis—lower doses result in treatment failure 1, 3
• Extend dosing intervals appropriately in renal impairment—failure to do so causes drug accumulation 1
• Monitor high-risk patients—suboptimal outcomes occur when therapeutic drug monitoring is overlooked in severe infections 1

Safety Profile

High loading doses (12 mg/kg twice daily) have an acceptable safety profile with nephrotoxicity occurring in approximately 7.9% of patients, with no increased risk compared to standard dosing when patients are appropriately monitored. 6