Evaluation of teicoplanin dosing designs to achieve a new target trough concentration

Ueda, Takashi; Takesue, Yoshio; Nakajima, Kazuhiko; Ichki, Kaoru; Wada, Yasunao; Tsuchida, Tetsuo; Takahashi, Yoshiko; Ishihara, Masataka; Tatsumi, Sumiyo; Kimura, Takeshi; Ikeuchi, Hiroki; Uchino, Motoi

doi:10.1007/s10156-011-0325-z

Cited by 43 publications

(46 citation statements)

References 22 publications

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“…7,8) Thus, we have recommended 15-30 µg/mL as the target trough concentration in the ICU. Recently, Ueda et al 9) also suggested 15-30 µg/mL as the new target. However, the initial loading procedure for teicoplanin to enable it to promptly reach the optimal concentration remains uncertain in critically ill patients with severe infections.…”

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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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%

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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“…3) In the standard teicoplanin regimen, a trough levels 15 30 mg/mL is di‹cult to achieve, even in patients with renal dysfunction. 13) In the present case, although teicoplanin trough levels were high (＞40 mg/mL), Ccr remained at 20 30 mL/min throughout teicoplanin administration above the target trough range. Therefore we consider that our recommended active loading dose and maintenance of teicoplanin at high trough levels (≧20 mg/mL) might be safe for renal impairment in patients with a Ccr of 20 40 mL/min.…”

Section: Discussionmentioning

confidence: 39%

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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“…Several studies have shown a relationship between TEIC serum concentration and clinical e‹ciency. 1,6,16) A logistic regression analysis showed that the probability of successful treatment with TEIC declined with age and increased with mean concentration at non-steady state. 5) A appropriate loading dose regimen must be considered mandatory for all patients, regardless of their renal function, to reach the range of appropriate concentrations early in the treatment period.…”

Section: Discussionmentioning

confidence: 99%

“…However, high-loading dose regimens in patients with impaired renal function have not been established. In fact, the mean trough concentration exceeded 30 mg/mL under the high-dosing regimen of 6 mg/kg twice daily for 3 d. 6,7) Therapeutic drug monitoring (TDM) is recommended to ensure an adequate trough concentration at steady state according to renal function. Recent reports have indicated that dose adjustment based on individual renal function and weight using TDM software for TEIC, based on population pharmacokinetics (PPK), is useful for determining the dose of TEIC.…”

Section: Introductionmentioning

confidence: 99%

Improvement of Predictivity of Teicoplanin Serum Trough Concentrations at Steady State Calculated by Vancomycin Pharmacokinetic Parameter

Kobayashi

Otomo²,

Shiba³

et al. 2016

YAKUGAKU ZASSHI

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According to a recent study and meta-analysis, trough levels of ＞10 mg/mL teicoplanin (TEIC) may be acceptable for the treatment of uncomplicated infection, but no method of TEIC personalized medicine has been established. Vancomycin (VCM) and TEIC are glycopeptide antibiotic agents eŠective against methicillin-resistance Staphyloccocus aureus. This study aimed to establish TEIC personalized medicine at a steady state calculated by VCM pharmacokinetic parameters. Bayesian forecasting and population mean methods were employed to estimate individual total VCM clearance (CL) using existing population pharmacokinetics (PPK) parameter, and the diŠerences between the CL calculated by these two methods were deˆned as DCL. Serum drug concentration data for patients treated with TEIC were collected at a steady state concentration (＞96 h post infusion). There was a signiˆcant relationship between the prediction error of TEIC trough level and DCL. The relation between DCL and TEIC trough concentration at steady state was used to develop the following equation to determine the maintenance dose: TEIC (mg/mL)＝1.1119X-6.124DCL＋3.9164 (X is deˆned as TEIC trough concentration calculated from the PPK parameter). The results of this study indicated that it is possible to improve the prediction error of TEIC trough concentration at a steady state for patients who have received VCM therapy.

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Evaluation of teicoplanin dosing designs to achieve a new target trough concentration

Cited by 43 publications

References 22 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

Improvement of Predictivity of Teicoplanin Serum Trough Concentrations at Steady State Calculated by Vancomycin Pharmacokinetic Parameter

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