What are the recommended teicoplanin dosing regimens for adults (loading and maintenance for uncomplicated and severe infections) and children, and how should the dose be adjusted in renal impairment?

Teicoplanin Dosing Recommendations

Adult Dosing

For adults with serious MRSA infections, administer a loading dose of 6-12 mg/kg IV every 12 hours for 3 doses, followed by maintenance dosing 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

Loading Dose Regimen

• Standard infections (uncomplicated pneumonia, skin/soft tissue infections): 6-12 mg/kg IV every 12 hours for 3 doses (at 0,12, and 24 hours) 1, 2
• Severe/complicated infections (endocarditis, osteomyelitis, septic arthritis, complicated bacteremia): Use the higher end of the range (10-12 mg/kg) every 12 hours for 3-6 doses 1, 2
• Critically ill patients: Consider aggressive loading of 25-30 mg/kg to rapidly achieve therapeutic levels due to expanded extracellular volume from fluid resuscitation 1, 2
• Critical principle: Never reduce the loading dose for renal impairment—loading depends on volume of distribution, not clearance 2, 3

Maintenance Dose Regimen (Normal Renal Function)

• Standard infections: 6-12 mg/kg IV once daily 1
• Complicated infections: 10-12 mg/kg IV once daily 1
• Target trough concentrations: ≥10 mg/L for standard infections, ≥20 mg/L for severe infections 2

Renal Dose Adjustments (Maintenance Phase Only)

The loading dose remains unchanged regardless of renal function. 2, 4 Adjust only the maintenance dosing interval:

• CrCl 40-60 mL/min: 6-10 mg/kg every 24 hours 2
• CrCl 20-40 mL/min: 6-10 mg/kg every 48 hours 2, 4
• CrCl <20 mL/min: 6-10 mg/kg every 72 hours 2, 4

Practical Example

A 70 kg adult with serum creatinine 1.6 mg/dL (CrCl ~40-60 mL/min) and severe MRSA bacteremia would receive:

• Loading: 700-840 mg IV every 12 hours for 3 doses 1, 2
• Maintenance: 700-840 mg IV once daily 2

Pediatric Dosing

Pediatric patients should receive a loading dose of 10 mg/kg IV every 12 hours for 3 doses, followed by maintenance of 6-10 mg/kg IV once daily, with higher doses (10-12 mg/kg) for severe infections. 4

Loading Dose

• Standard loading: 10 mg/kg IV every 12 hours for 3 doses 4
• Severe infections (endocarditis, septic arthritis, osteomyelitis): 12 mg/kg IV every 12 hours for 3 doses 4
• Maximum single dose: 400 mg 1

Maintenance Dose

• Normal renal function: 6-10 mg/kg IV every 24 hours 4
• Severe infections: 10-12 mg/kg IV every 24 hours 4

Pediatric Renal Adjustments (Maintenance Only)

Loading doses do not change with renal impairment in children. 4

• Mild renal impairment: 6-10 mg/kg every 24 hours 4
• Moderate renal impairment: 6-10 mg/kg every 48 hours 4
• Severe renal impairment: 6-10 mg/kg every 72 hours 4

Therapeutic Drug Monitoring

Mandatory monitoring situations include: 2, 4

• S. aureus endocarditis or septic arthritis
• Major burns or IV drug users
• Rapidly changing renal function
• Immunocompromised patients
• All pediatric patients (due to highly variable pharmacokinetics) 4

Common Pitfalls to Avoid

• Never reduce loading doses in renal failure—this is the most critical error, as therapeutic levels will be delayed by days 2, 3
• Standard 400 mg daily dosing frequently produces subtherapeutic levels; higher doses (600 mg or weight-based 10-12 mg/kg) are often necessary 5
• Without adequate loading, therapeutic concentrations may not be achieved until day 7-11 of therapy 3
• Higher loading doses (12 mg/kg) achieve therapeutic levels by day 2-3 versus day 7+ with lower doses (6 mg/kg) 6