What is the recommended adult dose of Targocid (Teicoplanin) intravenous (IV) injection?

Targocid (Teicoplanin) Adult Dosing for Injection

For adult patients with normal renal function, administer Targocid with a loading dose of 6 mg/kg (or 400 mg) intravenously every 12 hours for three doses, followed by a maintenance dose of 6 mg/kg (or 400 mg) once daily; for severe infections such as endocarditis or septic arthritis, use a higher loading dose of 12 mg/kg every 12 hours for three doses, followed by 12 mg/kg once daily. 1, 2

Standard Dosing Regimen

Loading Phase

• Standard infections: 6 mg/kg IV every 12 hours for 3 doses (total of 3 doses over 48 hours) 1, 3, 4
• Severe infections (endocarditis, septic arthritis, osteomyelitis): 12 mg/kg IV every 12 hours for 3 doses 1, 5
• A loading dose of 25-30 mg/kg may be considered for seriously ill patients to rapidly achieve therapeutic levels 2

Maintenance Phase

• Standard infections: 6 mg/kg IV once daily 1, 3, 4
• Severe infections: 12 mg/kg IV once daily 1, 5
• Recent evidence suggests that 600 mg daily (approximately 8-10 mg/kg for average adults) achieves therapeutic levels more reliably than 400 mg daily without increased toxicity 6

Dose Adjustments for Renal Impairment

The loading dose remains unchanged regardless of renal function, but maintenance dosing intervals must be extended based on creatinine clearance. 1, 3

• Normal renal function (GFR >90 mL/min): 6-12 mg/kg every 24 hours 1
• Moderate impairment (GFR 50-90 mL/min): 6-12 mg/kg every 24 hours 1
• Severe impairment (GFR 10-50 mL/min): 6-12 mg/kg every 48 hours 1
• End-stage renal disease (GFR <10 mL/min): 6-12 mg/kg every 72 hours 1

Hemodialysis Patients

• Loading dose: 12 mg/kg, followed by 6 mg/kg on days 2 and 3 1
• Maintenance: 6 mg/kg once weekly 1
• Administer after dialysis to avoid premature drug removal 2

Infection-Specific Dosing

Skin and Soft Tissue Infections (Complicated)

• Loading: 6-12 mg/kg IV every 12 hours for 3 doses 2, 1
• Maintenance: 6-12 mg/kg once daily 2, 1
• Duration: 7-14 days 2, 1

Bacteremia

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

Endocarditis

• Native valve: 12 mg/kg IV every 12 hours for 3 doses, then 12 mg/kg once daily for 4-6 weeks 2, 1, 5
• Prosthetic valve: Same dosing for 6 weeks, often combined with rifampin 2
• Target trough levels ≥20 mg/L for endocarditis 1, 5

Pneumonia

• Loading: 6-12 mg/kg IV every 12 hours for 3 doses 2, 1
• Maintenance: 6-12 mg/kg once daily 2, 1
• Duration: 7-21 days 2

Osteomyelitis and Septic Arthritis

• Loading: 6-12 mg/kg IV every 12 hours for 3 doses 2, 1
• Maintenance: 6-12 mg/kg once daily 2, 1
• Duration: >6 weeks for osteomyelitis, 3-4 weeks for septic arthritis 2, 1

Administration Considerations

• Route: Intravenous or intramuscular (both well tolerated) 3, 7
• Infusion time: Can be given as IV bolus or rapid infusion 3, 7
• Steady state: Reached slowly (93% after 14 days), hence the importance of loading doses 3
• Protein binding: 90% bound to plasma proteins 3

Therapeutic Drug Monitoring

Routine monitoring is not generally required but is strongly recommended for specific situations. 1

Indications for Monitoring

• Severe infections (endocarditis, septic arthritis) - target trough ≥20 mg/L 1, 5
• Patients with major burns 1, 3
• Intravenous drug users 1, 3
• Rapidly changing renal function 1
• Patients not responding to treatment 3

Target Trough Levels

• Standard infections: ≥10 mg/L 1, 3
• Severe infections: ≥20 mg/L 1, 5
• Potentially toxic: >60 mg/L 6

Important Clinical Caveats

• Higher doses needed in special populations: Burn patients and IV drug abusers may require higher doses due to unpredictable clearance 3
• Bone penetration: Doses of 10 mg/kg are necessary to achieve adequate bone concentrations (7 mg/L at 12 hours) 3
• Poor CNS penetration: Little penetration into cerebrospinal fluid; not ideal for meningitis 3, 7
• Nephrotoxicity: Much lower risk compared to vancomycin; renal impairment requiring discontinuation occurs in only about 2% of patients 6
• No serum monitoring for toxicity: Unlike vancomycin, routine monitoring is not necessary to avoid toxicity 3, 4
• Combination therapy: For endocarditis, combination with aminoglycosides allows use of standard 6 mg/kg dose rather than 12 mg/kg 5, 4