Determination of teicoplanin trough concentration target and appropriate total dose during the first 3 days: a retrospective study in patients with MRSA infections

Matsumoto, Kazuaki; Kanazawa, Naoko; Ikawa, Kazuro; Fukamizu, Tomohide; Shigemi, Akari; Yaji, Keiko; Shimodozono, Yoshihiro; Morikawa, Norifumi; Takeda, Yasuo; Yamada, Katsushi

doi:10.1007/s10156-010-0038-8

Cited by 39 publications

(39 citation statements)

References 27 publications

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“…Pea et al recommended that an initial loading dose of 6 mg/kg every 12 h for 3 doses is warranted for critically ill patients 10) ; however, this initial loading procedure could not promptly achieve a trough concentration of >15.0 µg/mL. 3,8) This study aimed to determine the appropriate initial loading procedure for teicoplanin in critically ill patients with severe infections. Therefore, 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.…”

Section: Development Of Initial Loading Procedures For Teicoplanin In mentioning

confidence: 99%

“…3,4) As trough concentrations are closely related to clinical outcomes, therapeutic drug monitoring (TDM) is recommended to maintain adequate trough concentrations. 3,4) TDM is also recommended to achieve a teicoplanin trough concentration of ≥10 mg/L for each patient, 3) but we have experienced teicoplanin having no effect at this concentration. 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.…”

Section: Development Of Initial Loading Procedures For Teicoplanin In mentioning

confidence: 99%

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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: 99%

Section: Development Of Initial Loading Procedures For Teicoplanin In mentioning

confidence: 99%

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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“…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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“…Therapeutically effective plasma concentrations of teicoplanin are achieved with minimal delay in most patients when appropriately high loading doses are administered, resulting in improved outcomes for patients with severe multidrug-resistant Gram-positive infections. 5,8 The optimal pharmacodynamical parameter of the area under the curve (AUC) (24 hours)/minimum inhibitory concentration (MIC), adequate teicoplanin serum and site of infection concentrations, as well as the MIC for the pathogen, are important determinants of therapeutic outcome. [9][10][11] Being non-ribosomal peptides, the glycopeptide antibiotics are generally synthesised by highly specific enzymes which are naturally expressed in some Actinobacteria.…”

Section: Introductionmentioning

confidence: 99%

“…6,7 The pharmacokinetics of teicoplanin are characterised by a long elimination half-life of 30-180 hours, implying that there is a prolonged period before steady-state concentration is achieved. 8 Therefore, an initial multiple-dose loading schedule was recommended to enable the rapid ach ievement of therapeutic serum concentrations. Therapeutically effective plasma concentrations of teicoplanin are achieved with minimal delay in most patients when appropriately high loading doses are administered, resulting in improved outcomes for patients with severe multidrug-resistant Gram-positive infections.…”

Section: Introductionmentioning

confidence: 99%

A multi-centre, phase IV study to evaluate the steady-state plasma concentration and serum bactericidal activity of a generic teicoplanin preparation

Greeff

Tonder

Cromarty

et al. 2015

Southern African Journal of Infectious Diseases

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Introduction:Teicoplanin is an effective treatment option against methicillin-resistant, Gram-positive bacteria, like Staphylococcus aureus. It is a glycopeptide antibiotic, produced through microbial fermentation, a process resulting in variations in the N-acyl side chain. Concerns that these variations may affect the pharmacokinetic profile and the clinical efficacy of generic teicoplanin preparations have been raised. Method: To address this issue, a multi-centre observational study was conducted to evaluate steady-state peak and trough serum concentrations, and the serum bactericidal activity (SBA) and safety of a generic teicoplanin preparation in critically ill patients. Additionally, the composition of the generic teicoplanin was compared to that of the innovator drug to assess differences in the composition. Results: Following pre-determined loading and maintenance dose schedules, the mean peak and trough teicoplanin serum concentrations were 20.98 mg/l and 10.38 mg/l, respectively. A statistically significant association was observed between teicoplanin pharmacotherapy and increased ex vivo SBA. It was found using independent analysis that the composition of the generic teicoplanin preparation was similar to that of the innovator drug, and that both formulations met the European Pharmacopoeia specifications. Conclusion:The loading and maintenance schedules employed in this study were effective in establishing therapeutic serum teicoplanin concentrations in critically ill patients. Evidence of bactericidal activity measured in patients' ex vivo serum samples, following treatment with the generic preparation, supports this finding.

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Determination of teicoplanin trough concentration target and appropriate total dose during the first 3 days: a retrospective study in patients with MRSA infections

Cited by 39 publications

References 27 publications

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

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

A multi-centre, phase IV study to evaluate the steady-state plasma concentration and serum bactericidal activity of a generic teicoplanin preparation

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