What is the recommended dose of Teicoplanin (injection Teicoplanin)?

Teicoplanin Dosing Recommendations

For standard infections, administer teicoplanin with a loading dose of 6 mg/kg IV every 12 hours for three doses, followed by 6 mg/kg once daily maintenance; for severe infections (endocarditis, septic arthritis, complicated bacteremia), use a loading dose of 12 mg/kg IV every 12 hours for three doses, followed by 12 mg/kg once daily maintenance. 1, 2

Standard Dosing Algorithm

Loading Phase

• Standard infections: 6 mg/kg IV every 12 hours for three doses (total of three doses over 48 hours) 3, 1
• Severe infections (S. aureus endocarditis, septic arthritis, complicated bacteremia): 12 mg/kg IV every 12 hours for three doses 1, 2, 4
• The higher loading dose is critical for achieving rapid therapeutic concentrations, with 90-100% of patients reaching target levels by days 2-3 compared to only 16-18% with standard dosing 5

Maintenance Phase (Normal Renal Function)

• Standard infections: 6 mg/kg IV once daily 1, 6
• Severe infections: 12 mg/kg IV once daily to achieve target trough ≥20 mg/L 1, 2, 7
• For endocarditis specifically, 12 mg/kg daily or combination therapy with aminoglycosides is necessary, as monotherapy with 6 mg/kg has shown inferior cure rates 7

Infection-Specific Dosing

Complicated Skin and Soft Tissue Infections

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

Bacteremia

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

Endocarditis

• Native valve: 12 mg/kg IV every 12 hours for three doses, then 12 mg/kg once daily for 4-6 weeks 1, 4, 7
• Prosthetic valve: Same dosing for 6 weeks in combination with rifampin and gentamicin 1
• Target trough concentration ≥20 mg/L 2, 4

Pneumonia

• 6-12 mg/kg IV every 12 hours for three doses, then 6-12 mg/kg once daily 3
• Duration: 7-21 days depending on clinical response 1

Osteomyelitis and Septic Arthritis

• 12 mg/kg IV every 12 hours for three doses, then 12 mg/kg once daily 1, 7
• Duration: >6 weeks for osteomyelitis, 3-4 weeks for septic arthritis 1

Renal Dose Adjustments

Maintenance Dosing by GFR

• GFR >90 mL/min: Every 24 hours 1
• GFR 50-90 mL/min: Every 24 hours 1
• GFR 10-50 mL/min: Every 48 hours 1, 2
• GFR <10 mL/min: Every 72 hours 1

Hemodialysis

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

Critical Pitfalls to Avoid

Inadequate Loading Doses

• The standard 400 mg daily dose (approximately 6 mg/kg) frequently results in subtherapeutic levels, with only 37% achieving target concentrations 8
• For severe infections, failure to use 12 mg/kg loading doses delays therapeutic levels by several days 5

Premature Transition to Oral Therapy

• Maintain parenteral therapy throughout the treatment course for complicated bacteremia and endocarditis 1
• Oral transition should not be done in complicated bacteremia to prevent relapse 1

Inadequate Maintenance Dosing for Severe Infections

• Using 6 mg/kg daily for endocarditis as monotherapy has shown poor cure rates compared to vancomycin 7
• Either increase to 12 mg/kg daily or add aminoglycoside combination therapy 7

Stopping Therapy Based on Symptom Resolution

• Complete the full duration based on infection type (4-6 weeks for complicated bacteremia, 4-6 weeks for endocarditis) to prevent relapse 1

Therapeutic Drug Monitoring

• Not routinely required for standard infections 1
• Indicated for: S. aureus endocarditis, septic arthritis, major burns, IV drug users, rapidly changing renal function 1
• Target trough for severe infections: ≥20 mg/L 1, 2, 4
• Higher doses (600 mg daily in adults with normal renal function) achieve therapeutic levels in 68% of patients without increased toxicity 8