An assessment of teicoplanin use and monitoring serum levels in a Chinese teaching hospital

Yan, Dong; Hy, Dong; Ss, Hu; Wang, X; Yx, Wei; My, Wang; Wh, Dong; Hp, Yao; Hs, You; Jf, Xing

doi:10.5414/cp201374

Cited by 11 publications

(10 citation statements)

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“…Dong et al reported that the mean trough concentrations were 13.0 µg/mL in patients with microbiological eradication and improvements in the symptoms of diseases. 5) We also showed that mean trough concentrations were 13.2 µg/mL for MRSA eradication.…”

Section: Development Of Initial Loading Procedures For Teicoplanin In mentioning

confidence: 86%

Development of Initial Loading Procedure for Teicoplanin in Critically Ill Patients with Severe Infections

Matsumoto

Kanazawa

Watanabe

et al. 2013

Biological & Pharmaceutical Bulletin

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Methicillin-resistant Staphylococcus aureus (MRSA) is now endemic in many hospitals. Infection with MRSA is more frequent in the intensive care unit (ICU) than in general wards. Therefore, appropriate treatments for MRSA infections will lead to good outcomes in the ICU. Teicoplanin is an anti-MRSA agent. Recently, it was recommended at a new target trough concentration of 15-30 µg/mL. However, the initial loading procedure for teicoplanin to allow it to reach the target concentration promptly remains uncertain. Therefore, this study aimed to determine the appropriate initial loading procedure for teicoplanin in critically ill patients with severe infections. We performed a retrospective study in patients given teicoplanin in the ICU in order to determine the initial loading procedure to promptly reach the target trough concentration. We then evaluated the trough concentration on the third day after commencement of teicoplanin therapy. The mean loading dose and trough concentration were 11.5±1.0 mg/kg and 18.9±5.9 µg/mL, respectively. A correlation (r=0.45, p=0.046) was shown between teicoplanin loading dose and trough concentration. The correlation equation was trough concentration=2.563·loading dose −10.672. In the cases of 11.0 and 15.0 mg/ kg for the loading dose, respectively, trough concentrations were 17.5 and 27.8 µg/mL. We suggested that an initial loading dose of 11-15 mg/kg every 12 h for 3 doses should be administered to promptly achieve the target trough concentration of 15-30 µg/mL on the third day after commencement of teicoplanin therapy in the ICU.

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Section: Development Of Initial Loading Procedures For Teicoplanin In mentioning

confidence: 86%

Development of Initial Loading Procedure for Teicoplanin in Critically Ill Patients with Severe Infections

Matsumoto

Kanazawa

Watanabe

et al. 2013

Biological & Pharmaceutical Bulletin

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“…This is consistent with previous research. 9 , 14 , 15 , 17 , 20 , 21 , 23 , 27 , 29 All patients were divided into groups based on Cl cr and loading regimens. As a result, ratios of the 3-day loading dose to Cl cr and C min were significantly correlated ( R =0.59, P <0.001; Figure 4 ).…”

Section: Discussionmentioning

confidence: 99%

“…The drug label approved by the China Food and Drug Administration recommends a load dosage of 200 mg or 400 mg one to three times at 12-hour intervals, followed by maintenance dosing of 200 mg or 400 mg/day; however, this treatment regimen results in poor clinical efficacy. 23 In clinical practice, doctors must increase the loading dose to achieve the desired effect, but this is illegal in the view of the drug administration. Therefore, it is urgently necessary to determine the optimal load and maintenance doses to ensure clinical efficacy and safety in Chinese patients.…”

Section: Introductionmentioning

confidence: 99%

Retrospective analysis of relationships among the dose regimen, trough concentration, efficacy, and safety of teicoplanin in Chinese patients with moderate–severe Gram-positive infections

Zhou¹,

Gao²,

Cao³

et al. 2018

IDR

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ObjectivesTeicoplanin, an antibiotic, has poor clinical efficacy when using the current drug label’s recommended regimen, which is approved by the China Food and Drug Administration. This study explores the appropriate loading and maintenance doses of teicoplanin and evaluates the therapeutic target of teicoplanin trough concentration (minimum concentration [Cmin]).Subjects and methodsAll patients treated with teicoplanin from February 2015 to August 2016 at Zhengzhou Central Hospital were screened for enrollment. A total of 113 subjects were included and then divided into four groups: A (received three to six doses at a loading dose of 400 mg at 12-hour intervals, followed by maintenance dosing of 400 mg/day), B (received three doses at a loading dose of 400 mg at 12-hour intervals, followed by maintenance dosing of 400 mg/day), C (received two doses at a loading dose of 400 mg at 12-hour intervals, followed by maintenance dosing of 200 mg/day), and D (received one to three doses at a loading dose of 400 mg at 12-hour intervals, followed by maintenance dosing of 200 mg/day). Cmin values of teicoplanin were detected with high-performance liquid chromatography on day 4, 30 minutes before maintenance-dose administration. Teicoplanin Cmin, efficacy, and safety were compared among the four groups.ResultsMean Cmin differed significantly among the four groups (A, 18.11±6.37 mg/L; B, 15.91±4.94 mg/L; C, 17.06±5.66 mg/L; D, 11.97±3.76 mg/L) (P<0.001), with creatinine clearance of 89.62 (53.72–162.48), 49.66 (40.69–59.64), 27.17 (9.7–39.45), and 96.6 (17.63–394.73) mL/min, respectively. The ratio of loading dose for 3 days to creatinine clearance and serum Cmin were significantly correlated (R=0.59, P<0.001). The correlation between the estimated probability of success and teicoplanin Cmin was assessed using binary logistic regression (OR 2.049, P<0.001). Hepatotoxicity- and nephrotoxicity-incidence rates did not significantly differ among the four groups (P=0.859 and P=0.949, respectively).ConclusionA loading dose of 400 mg at 12-hour intervals three to six times is needed to achieve the early target range (15–20 mg/L) and improve the clinical efficacy rate for normal-renal-function patients. It is urgently necessary to amend the drug label for the recommended regimen.

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“…Generally, Clinician recommend that a teicoplanin trough level of ≧10 mg/mL should be achieved for treating the majority of infections. 5,10,11) However, current recommendations suggest that teicoplanin trough levels should be maintained at ＞20 mg/mL for severe infections. 12,13) Therefore, we consider that a re-loading dose should be administered after theˆrst TDM so that the teicoplanin trough level reaches the target range at the second TDM.…”

Section: Discussionmentioning

confidence: 99%

Long-term Treatment of Teicoplanin for Methicillin-resistant <i>Staphylococcus aureus</i> Sternal Osteomyelitis with Renal Impairment: A Case of High Teicoplanin Trough Levels Maintained by Therapeutic Drug Monitoring

et al. 2016

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Teicoplanin, a glycopeptide antibiotic for methicillin-resistant Staphylococcus aureus, is recommended for therapeutic drug monitoring during treatment. Maintaining a high trough range of teicoplanin is also recommended for severe infectious disease. However, the optimal dose and interval of treatment for severe renal impairment is unknown. We report a 79-year-old man who received long-term teicoplanin treatment for methicillin-resistant Staphylococcus aureus bacteremia due to postoperative sternal osteomyelitis with renal impairment. Plasma teicoplanin trough levels were maintained at a high range (20 30 mg/mL). Although the patient required long-term teicoplanin treatment, a further decline in renal function was not observed, and blood culture remained negative after the start of treatment. Teicoplanin treatment that is maintained at a high trough level by therapeutic drug monitoring might be beneˆcial for severe methicillin-resistant Staphylococcus aureus infection accompanied by renal impairment.

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An assessment of teicoplanin use and monitoring serum levels in a Chinese teaching hospital

Cited by 11 publications

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Development of Initial Loading Procedure for Teicoplanin in Critically Ill Patients with Severe Infections

Development of Initial Loading Procedure for Teicoplanin in Critically Ill Patients with Severe Infections

Retrospective analysis of relationships among the dose regimen, trough concentration, efficacy, and safety of teicoplanin in Chinese patients with moderate–severe Gram-positive infections

Long-term Treatment of Teicoplanin for Methicillin-resistant <i>Staphylococcus aureus</i> Sternal Osteomyelitis with Renal Impairment: A Case of High Teicoplanin Trough Levels Maintained by Therapeutic Drug Monitoring

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An assessment of teicoplanin use and monitoring serum levels in a Chinese teaching hospital

Cited by 11 publications

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Development of Initial Loading Procedure for Teicoplanin in Critically Ill Patients with Severe Infections

Development of Initial Loading Procedure for Teicoplanin in Critically Ill Patients with Severe Infections

Retrospective analysis of relationships among the dose regimen, trough concentration, efficacy, and safety of teicoplanin in Chinese patients with moderate&ndash;severe Gram-positive infections

Long-term Treatment of Teicoplanin for Methicillin-resistant <i>Staphylococcus aureus</i> Sternal Osteomyelitis with Renal Impairment: A Case of High Teicoplanin Trough Levels Maintained by Therapeutic Drug Monitoring

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Retrospective analysis of relationships among the dose regimen, trough concentration, efficacy, and safety of teicoplanin in Chinese patients with moderate–severe Gram-positive infections