Optimal trough concentration of teicoplanin for the treatment of methicillin‐resistant
            <i>Staphylococcus aureus</i>
            infection: A systematic review and meta‐analysis

Hanai, Yuki; Takahashi, Yoshiko; Niwa, Takashi; Mayumi, Toshihiko; Hamada, Yukihiro; Kimura, Toshimi; Matsumoto, Kazuaki; Fujii, Satoshi; Takesue, Yoshio

doi:10.1111/jcpt.13366

Cited by 13 publications

(16 citation statements)

References 36 publications

(81 reference statements)

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“…Our previous studies indicated that the trough concentration (C min ) of TEI is correlated with the clinical efficacy of TEI therapy ( Tang et al, 2020 ; Ren et al, 2021 ). It has been recommended that the C min of TEI (at least 10 μg/ml is required for non-complicated MRSA infections) should be maintained at 15–30 μg/ml for most of the methicillin-resistant Staphylococcus aureus (MRSA) infections ( Abdul-Aziz et al, 2020 ; Hanai et al, 2021 ). Our previous studies suggested that a high-loading and maintenance dosage regimen (6–12 mg/kg, q12 h × 3 doses and 6–12 mg/kg qd) is required to maintain the C min of TEI in its therapeutic range at the early stage of treatment, and no reduction in the loading dose is required for renal dysfunction patients ( Tang et al, 2020 ; Ren et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Dose Optimization of Teicoplanin for Critically Ill Patients With Renal Dysfunction and Continuous Renal Replacement Therapy: Experience From a Prospective Interventional Study

et al. 2022

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Background: Due to the lack of updated information on teicoplanin (TEI) for continuous renal replacement therapy (CRRT), no exact dosage regimen has been recommended. The aim of this study was to optimize the dosage regimen of TEI in renal dysfunction patients with or without CRRT, evaluate the influence factors of the eradication of Gram-positive bacteria, and evaluate the effect of CRRT on the clearance of TEI.Methods: Patients with renal dysfunction receiving TEI treatment in the ICU were prospectively recruited and divided into CRRT and non-CRRT groups. Logistic regression analysis was used to screen the factors affecting the eradication of Gram-positive bacteria. The filtrate concentration of the CRRT group was measured at the time of TEI Cmin, and the filtration coefficient of TEI was calculated to evaluate the effect of CRRT on the clearance of TEI.Results: A total of 106 patients were included, 40 cases in the CRRT group and 66 cases in the non-CRRT group. After giving high-loading doses of TEI, 75.8 and 70% of TEI Cmin in the non-CRRT and CRRT groups reached the range of 10–30 mg/L before the 3rd dose, respectively. The risk of G+ bacteria being uneradicated was higher while the APACHEⅡscore was higher than 22.5. The albumin level before the start of TEI administration and before the 6th–8th dose was lower than 32.8 g/L and 29.3 g/L, respectively, and Cmin before the 3rd dose and 6th–8th dose was lower than 13.2 mg/L and 17.1 mg/L, respectively, with the duration of TEI therapy shorter than 10.5 days. The correlation coefficient (r) was 0.6490 between Cmin before the 3rd dose and the albumin level (p < 0.001). The filtration coefficient of TEI was 10.7 ± 2.4% at Cmin and 11.1 ± 2.5% at Cmax. The GFR had no correlation with the filtration coefficient (r = −0.06204; r = −0.08059). The clearance of TEI in CRRT patients was negatively correlated with the albumin level (r = −0.6305, p = 0.0013).Conclusion: The early stage of the albumin level can significantly affect the initial Cmin and clinical efficacy of TEI, and also had effect on the clearance of TEI by CRRT. The filtration coefficient of TEI was stable, even with a higher ultrafiltration rate.

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Section: Introductionmentioning

confidence: 99%

Dose Optimization of Teicoplanin for Critically Ill Patients With Renal Dysfunction and Continuous Renal Replacement Therapy: Experience From a Prospective Interventional Study

et al. 2022

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“…Hanai et al believed that the clinical efficacy was better when C min was 15–30 mg/L than when it was <15 mg/L, 29 and another study also found that the treatment failed when patients with ARC used standard dosages 2 . The presents study did not find a significant difference in the clinical effectiveness rate between the ARC and non‐ARC groups (77.3% vs. 62.5%, respectively; p = 0.227) or between the HD and LD groups (73.9% vs. 65.2%, respectively; p = 0.522).…”

Section: Discussionmentioning

confidence: 99%

“…C min was 15-30 mg/L than when it was <15 mg/L, 29 and another study also found that the treatment failed when patients with ARC used standard dosages. 15 Therefore, to determine whether the clinical efficacy could be further affected by teicoplanin exposure when ARC is present, a larger sample should be used to address the limitations associated with the small numbers of cases in these studies.…”

Section: Hanai Et Al Believed That the Clinical Efficacy Was Better Whenmentioning

confidence: 95%

Plasma trough concentration distribution and safety of high‐dose teicoplanin for patients with augmented renal clearance

Wang

You

et al. 2022

Clinical Pharmacy Therapeu

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What Is Known and Objective There are few reports on the distribution of the plasma trough concentration (Cmin) of teicoplanin in patients with augmented renal clearance (ARC) and on the safety of a high‐dose regimen (HD; 800 mg loading dose for q12h three times followed by an 800 mg qd maintenance dose). The objective of this study was to determine the Cmin values of teicoplanin in ARC patients using HD teicoplanin to provide a reference for individualized medication. Methods Data on patients treated with teicoplanin from January 2019 to January 2021 were collected retrospectively and divided into ARC (creatinine clearance rate [CCr] >130 ml/min, n = 22) and non‐ARC (60 ml/min ≤ CCr ≤130 ml/min, n = 24) groups. The Cmin values in the two patient groups were analysed during the HD and the low‐dose regimen (LD; all other regimens) on the third day of medication and during the dose maintenance period. Liver and kidney function indexes were also analysed before and after medication. Results and Discussions On the third day of the HD, Cmin did not differ significantly between the ARC and non‐ARC groups (17.3 ± 9.2 mg/L [mean ± SD] vs. 15.5 ± 7.9 mg/L, p = 0.663), while Cmin in the ARC group was significantly lower for the LD (6.8 ± 3.9 mg/L, p = 0.039). During the dose maintenance period, Cmin in the ARC group when receiving the HD (18.3 ± 5.1 mg/L) was significantly lower than that in the non‐ARC group (25.5 ± 11.9 mg/L, p = 0.016) and significantly higher than that for the LD (12.2 ± 6.3 mg/L, p = 0.022). Nephrotoxicity and hepatotoxicity incidence rates did not differ significantly between these groups. What Is New and Conclusion These results suggest that it is necessary to apply a loading dose of 800 mg (but not higher) q12h three times for patients with ARC, with 800 mg needed as a maintenance dose during severe infection, and 600 mg or 400 mg for mild infection.

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“…Since it is difficult to obtain multiple serum teicoplanin concentrations to determine the AUC in the clinical setting, trough serum concentration monitoring is used as a surrogate marker for AUC to monitor the teicoplanin levels. 5 …”

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

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Background Teicoplanin is a glycopeptide antimicrobial that treats serious invasive infections caused by gram-positive bacteria, such as the methicillin-resistant Staphylococcus aureus . Despite some comparable advantages, there is no guideline or clinical recommendation for teicoplanin in the pediatric population, unlike vancomycin where abundant studies and the recently revised guideline on therapeutic drug level monitoring (TDM) exist. Methods The systematic review was performed in accordance with the preferred reporting items for systematic reviews. Two authors (JSC and SHY) searched PubMed, Embase, and Cochrane Library databases using relevant terms independently. Results Fourteen studies were finally included with a total of 1,380 patients. TDM was available in 2,739 samples collected in the nine studies. Dosing regimens varied widely, and eight studies used recommended dosing regimens. Timing for measuring TDM was mostly 72–96 hours or longer after the initiation of the first dose, which was expected to be a steady-state. The majority of studies had target trough levels of 10 µg/mL or above. Three studies reported that the clinical efficacy and treatment success rate of teicoplanin was 71.4%, 87.5%, and 88%. Adverse events associated with teicoplanin use were described in six studies with a focus on renal and/or hepatic impairment. Except for one study, no significant relation was noted between the incidence of adverse events and trough concentration. Conclusion Current evidence on teicoplanin trough levels in pediatric populations is insufficient due to heterogeneity. However, target trough levels with favorable clinical efficacy are achievable by recommended dosing regimen in the majority of patients.

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Optimal trough concentration of teicoplanin for the treatment of methicillin‐resistant Staphylococcus aureus infection: A systematic review and meta‐analysis

Cited by 13 publications

References 36 publications

Dose Optimization of Teicoplanin for Critically Ill Patients With Renal Dysfunction and Continuous Renal Replacement Therapy: Experience From a Prospective Interventional Study

Dose Optimization of Teicoplanin for Critically Ill Patients With Renal Dysfunction and Continuous Renal Replacement Therapy: Experience From a Prospective Interventional Study

Plasma trough concentration distribution and safety of high‐dose teicoplanin for patients with augmented renal clearance

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

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