Clinical practice guidelines for therapeutic drug monitoring of teicoplanin: a consensus review by the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring

Abstract

Background Owing to its low risk of adverse effects, teicoplanin has been extensively used in patients with infections caused by MRSA. To promote the better management of patients receiving teicoplanin, we have updated the guidelines for therapeutic drug monitoring (TDM). Methods The guidelines were developed by a committee following the methodology handbook published by the Japanese Medical Information Distribution Service. Nine clinical questions were selected. The committee conducted a systematic review and meta-analysis to establish evidence-based recommendations for the target trough concentration (Cmin). An initial electronic database search returned 515 articles, and 97 articles qualified for a full review. Four and five studies were included for the efficacy evaluation of cut-off Cmin values of 15 and 20 mg/L, respectively. Results Compared with Cmin < 15 mg/L, a target Cmin value of 15–30 mg/L resulted in increased clinical efficacy in patients with non-complicated MRSA infections (OR = 2.68; 95% CI = 1.14–6.32) without an increase in adverse effects. Although there was insufficient evidence, target Cmin values of 20–40 mg/L were suggested in patients with complicated or serious MRSA infections. A 3 day loading regimen followed by maintenance treatment according to renal function was recommended to achieve the target trough concentrations. Because of the prolonged half-life of teicoplanin, measurement of the Cmin value on Day 4 before reaching steady state was recommended. Conclusions The new guideline recommendations indicate the target Cmin value for TDM and the dosage regimen to achieve this concentration and suggest practices for specific subpopulations.

Clinical Practice Guidelines for Therapeutic Drug Monitoring of Vancomycin in the Framework of Model-Informed Precision Dosing: A Consensus Review by the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring

“…For empirical therapy before MIC determination, the target AUC should be ≥400 μg·h/mL presuming an MIC of 1 μg/mL [ 16 , 102 , 145 , 146 , 147 , 151 , 152 , 153 , 154 , 155 , 156 , 157 , 158 ] (III-A).…”

“…A 1–8-fold increase in the vancomycin MIC was reported, possibly because of the decrease in unbound concentration as a result of the presence of albumin in the broth [ 102 ]. Because routine monitoring of the unbound concentration is not feasible in clinical practice, the target total concentration might be lowered depending on the degree of hypoalbuminemia in teicoplanin [ 16 , 158 ]. However, no recommendation for the desired vancomycin AUC was made in patients with severe hypo- or hyperalbuminemia in this guideline because of the unavailability of the outcome result from a clinical trial.…”

Optimal Use and Need for Therapeutic Drug Monitoring of Teicoplanin in Children: A Systematic Review

“… 14 16 However, the available clinical PK/PD data and recommendations for teicoplanin are relatively fewer than those of vancomycin. Recently, Members of the Japanese Society of Chemotherapy and the Japanese Society of Therapeutic Drug Monitoring have published clinical practice guidelines for TDM of teicoplanin, 49 based on their preceding systematic review and meta-analysis, which included four adult studies. 5 The guidelines have suggested practical and useful statements for several clinical issues on teicoplanin TDM.…”

“…Recent Japanese guidelines recommend performing the initial TDM on the fourth day of treatment before reaching steady state. 49 Generally, trough concentration is proposed to be measured after achieving steady-state concentration. 34 Because of its long half-life, teicoplanin requires longer time to achieve steady state than vancomycin.…”

Model‐informed precision dosing of teicoplanin for the rapid achievement of the target area under the concentration‐time curve: A simulation study

“…Teicoplanin is a glycopeptide antimicrobial used to treat infections caused by gram‐positive bacteria, including methicillin‐resistant Staphylococcus aureus (MRSA) 1 . Guidelines recommend therapeutic drug monitoring (TDM) to improve clinical response and reduce toxicity, wherein the pharmacokinetic target is a trough concentration of 15–40 μg/ml 2 . The trough concentration is the surrogate target instead of the ratio of the area under the concentration‐time curve (AUC) to the minimum inhibitory concentration (AUC/MIC) 3,4 .…”