Therapeutic Drug Level Monitoring of Teicoplanin in Korean Pediatric Patients with Normal versus Impaired Renal Function

Abstract

Background: Teicoplanin is used to treat serious gram-positive infections. Optimal teicoplanin trough levels are considered to be ≥ 10 μg/mL. Despite its wide use in various clinical settings, data on teicoplanin trough level in pediatric patients are limited. Therefore, the aim of this study was to investigate the therapeutic drug level monitoring of teicoplanin in Korean pediatric patients, including those with impaired renal function. Methods: A retrospective study was performed in pediatric patients (age ≤ 18 years old) who received teicoplanin from September 2014 to April 2018. The regimen included a loading dose of 10 mg/kg/dose at 12 hours' interval three times in a row, and a maintenance dose of 10 mg/kg/dose commenced at 24 hours of interval after the loading dose, with a maximum of 400 mg/dose, respectively. The first therapeutic drug levels were measured. Distribution and characteristics of trough levels in patients with decreased renal function and those with bacteremia were also assessed. Results: A total of 187 trough levels were collected from 143 patients. Hematologic and oncologic diseases were the most common underlying diseases (83.2%, n = 119). One hundred eighty trough levels were first measurements, their median value was 16.2 μg/mL (range, 2.3-100 μg/mL) and the median interval between initial teicoplanin injection and 1st trough level was 96.5 hours (range 47.6-179.3 hours). Lower steady-state levels were observed in younger age group (median, 13.5 vs. 18.0 μg/mL, P = 0.038). Median trough levels were higher in patients with decreased renal functions (P < 0.001). In addition, among eight with gram-positive bacteremia, seven of them had a favorable outcome. Conclusion: This study provides additive information on trough level monitoring of teicoplanin in children with impaired renal function and treatment effect in patients with gram-positive bacteremia. Careful monitoring for steady state trough levels of teicoplanin is warranted.

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

“… 15 21 22 23 24 25 26 27 28 29 30 31 32 33 Eight studies were single-center-based retrospective studies. 15 21 23 24 25 28 30 31 Of the remaining, two were multicenter based retrospective studies, 29 32 one was single-center-based prospective study, 33 and one was controlled trial of which randomization process was not clearly descripted. 26 Two studies did not state their study designs.…”

“… 26 Two studies did not state their study designs. 22 27 Seven studies were performed in Asia, 21 23 24 29 30 31 32 six were performed in Europe, 22 25 26 27 28 33 one study was performed in Australia. 15 Overall, a total of 1,380 patients from 14 articles were included.…”

Clinical pharmacology of teicoplanin in infants and children

“…A synergistic effect is observed with the co-administration of teicoplanin with cefotaxime and ofloxacin in gram-positive organisms [12] and with the combination of teicoplanin and netilmicin and amikacin in enterococci and staphylococci [13]. The treatment with teicoplanin has been studied in infants and children [14][15][16][17][18]. Infants with sepsis caused by staphylococci are cured with teicoplanin at a loading dose of 15 mg/kg followed by a maintenance dose of 8 mg/kg once-daily [14].…”

“…Infants with sepsis caused by staphylococci are cured with teicoplanin at a loading dose of 15 mg/kg followed by a maintenance dose of 8 mg/kg once-daily [14]. Children with infections due to grampositive organisms are cured with teicoplanin [15], and children with infections caused by gram-positive organisms are cured with teicoplanin at a dose of 10 mg/kg daily [16,17]. A loading dose of teicoplanin of 6 mg/kg twice-daily for at least three doses has been recommended in children with bacterial infection [18].…”

“…Of twenty-nine children with infections caused by gram-positive organisms 21 children (72.4%) are cured with teicoplanin [15]. Children, aged ≤ 18 years, had an infection caused by gram-positive organisms and are cured with teicoplanin at a dose of 10 mg/kg twice-daily [16]. Children, aged 2 to 12 years, with gram-positive infections are cured with teicoplanin at a dose 10 mg/kg daily [17].…”