Recommendations to achieve rapid therapeutic teicoplanin plasma concentrations in adult hospitalised patients treated for sepsis

Brink, AJ; Richards, Guy A.; Cummins, R.R.; Lambson, J.

doi:10.1016/j.ijantimicag.2008.05.012

Cited by 75 publications

(59 citation statements)

References 15 publications

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“…Doses of 6 mg/kg twice daily achieved serum concentrations of Ͼ10 g/ml by the second day of treatment. Thus, the administration of teicoplanin loading doses of 6 mg/kg twice daily for 48 h has been recommended for all infections, and for complicated infections, continuation of the high-dose regimen is recommended (6). Notably, in our review demonstrating the similar efficacies of teicoplanin and vancomycin, once-daily dosing of teicoplanin was used in all studies.…”

Section: Discussionmentioning

confidence: 99%

Comparative Efficacy and Safety of Vancomycin versus Teicoplanin: Systematic Review and Meta-Analysis

Svetitsky

Leibovici

Paul

2009

Antimicrob Agents Chemother

247

175

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Section: Discussionmentioning

confidence: 99%

Comparative Efficacy and Safety of Vancomycin versus Teicoplanin: Systematic Review and Meta-Analysis

Svetitsky

Leibovici

Paul

2009

Antimicrob Agents Chemother

247

175

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“…6) In current dosing strategies, a teicoplanin trough concentration of 20-30 µg/mL for deep-seated Gram-positive infections was targeted. 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.…”

Section: Development Of Initial Loading Procedures For Teicoplanin In mentioning

confidence: 99%

“…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%

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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“…We performed a study in patients with normal renal function, in whom the standard dose of 400 mg twice daily × 1 day and 400 mg daily thereafter was compared with 400 mg twice daily. [52] With the latter, a C min of 15 mg/L was achieved only on day 3, whereas with the former it was never achieved. In another study of 10 patients with chronic bone sepsis, 800 mg twice daily was administered for 48 hours and then 800 mg daily.…”

Section: Colistinmentioning

confidence: 90%

Optimising the administration of antibiotics in critically ill patients

2015

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Optimal outcome and a reduction in the potential for resistance require that appropriate pharmacokinetic (PK) targets are achieved. Consequently, we need to target drug concentrations that are significantly higher than those conventionally presumed to be adequate.Drug exposure varies according to the molecular weight, degree of ionisation, protein binding and lipid solubility of each agent. In critically ill patients, hypoalbuminaemia increases the free fraction of hydrophilic drugs, which in turn increases the volume of distribution and clearance (CL), both of which result in reduced drug levels. Similarly, augmented renal clearance (ARC), defined as a creatinine clearance (CLcr) of >130 mL/min/1.73 m 2 , which occurs frequently in critically ill patients, particularly younger patients with normal or near-normal creatinine levels, may also significantly reduce drug exposure. Studies have demonstrated a greater mortality and lower cure with ARC, particularly with the additive effects of obesity, hypoalbuminaemia and increasing resistance, if conventional dosages are used. These concepts apply to antibiotics targeting Gram-negative and -positive organisms. Knowledge of PK and the resistance profiles of organisms in each environment is necessary to prescribe appropriately. This article discusses these issues and the doses that should be used.

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Recommendations to achieve rapid therapeutic teicoplanin plasma concentrations in adult hospitalised patients treated for sepsis

Cited by 75 publications

References 15 publications

Comparative Efficacy and Safety of Vancomycin versus Teicoplanin: Systematic Review and Meta-Analysis

Comparative Efficacy and Safety of Vancomycin versus Teicoplanin: Systematic Review and Meta-Analysis

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

Optimising the administration of antibiotics in critically ill patients

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