Teicoplanin
General Information
This monograph is applicable to most medical and surgical wards and relates to treatment doses of teicoplanin only.
Dosing in sepsis patients is under Deep-Seated infection section below.
The dosing information is not applicable to the following clinical areas/conditions (see separate guidelines or contact Micro/ID):
- Pregnancy (antenatal or postnatal)
- Endophthalmitis
- Device related infections (DAIR, PJI, DBS, VA-VP shunt, EVD, Intravascular (excluding central vascular catheters))
- Renal unit
- Surgical prophylaxis
- Complex outpatient antimicrobial therapy
Restricted Formulary antimicrobial: Use in accordance with Trust guidelines. For details see OUH netFormulary
AWaRe antibiotic classification: 'Watch'. Use as per guidelines.
Intravenous dosing
For DEEP-SEATED infections (Sepsis, bone & joint infections, infective endocarditis):
|
Actual body weight (kg) |
Loading dose (12mg/kg) |
Maintenance dose (12mg/kg) |
|
44kg or less |
400mg every 12 hours for three doses |
400mg OD |
|
45-59kg |
600mg every 12 hours for three doses |
600mg OD |
|
60-74kg |
800mg every 12 hours for three doses |
800mg OD |
|
75-89kg |
1,000mg every 12 hours for three doses |
1,000mg OD |
|
90-104kg |
1,200mg every 12 hours for three doses |
1,200mg OD |
|
105-124kg |
1,400mg every 12 hours for three doses |
1,400mg OD |
|
125-139kg |
1,600mg every 12 hours for three doses |
1,600mg OD |
|
140-156kg |
1,800mg every 12 hours for three doses |
1,800mg OD |
|
157kg or over |
2,000mg every 12 hours for three doses |
2,000mg OD |
For NON DEEP-SEATED infections (skin & soft tissue infections):
|
Actual body weight (kg) |
Loading dose (6mg/kg) |
Maintenance dose (6mg/kg) |
|
44kg or less |
200mg every 12 hours for three doses |
200mg OD |
|
45-74kg |
400mg every 12 hours for three doses |
400mg OD |
|
75-109kg |
600mg every 12 hours for three doses |
600mg OD |
|
110-144kg |
800mg every 12 hours for three doses |
800mg OD |
|
145kg or more |
1,000mg every 12 hours for three doses |
1,000mg OD |
|
eGFR 30-80mL/min/1.73m2 |
Normal dose regimen on days 1–4 (see table above), then use normal maintenance dose every 48 hours |
|
eGFR less than 30mL/min/1.73m2 |
Normal dose regimen on days 1–4 (see table above), and then use normal maintenance dose every 72 hours |
Hepatic impairment
No information available. Use with caution in hepatic impairment.
Teicoplanin level monitoring
Teicoplanin level monitoring is only required in patients who will be treated for longer than 7 days.
- Plasma teicoplanin levels are not routinely measured because a relationship between plasma level and drug toxicity has not been established. However, monitoring of plasma teicoplanin level is needed to ensure that therapeutic levels of teicoplanin are achieved. There is minimal evidence for dose-related toxicity.
- Trends in renal function and serum teicoplanin levels should be considered when interpreting levels. For advice discuss with a pharmacist or or Micro/ID. The antimicrobial pharmacists are available on bleep 1549 Monday-Saturday if required.
Only trough (pre-dose) levels are taken. The first trough level should be taken between 6 and 8 days of treatment.
|
Trough level (mg/L) |
Teicoplanin level interpretation and dose adjustment |
||
|
Infective Endocarditis |
Bone and Joint Infection |
Other severe infections (e.g. skin and soft tissue, respiratory) |
|
|
Less than 10mg/L |
Move up one dose weight band. Repeat loading with the new dose. |
Move up one dose weight band. Repeat loading with the new dose. |
Repeat loading dose. Maintain with normal dose. |
|
10-14mg/L |
Move up one dose weight band. Repeat loading with the new dose. |
Repeat loading dose. Maintain with normal dose. |
Increase maintenance dose by 200mg |
|
15-19mg/L |
Repeat loading dose. Maintain with normal dose. |
Increase maintenance dose by 200mg |
Target trough level 15 – 30 mg/L. Continue with current dose. Re-check level one week later |
|
20-29mg/L |
Increase maintenance dose by 200mg |
Target trough level 20 – 40 mg/L. Continue with current dose. Re-check level one week later |
|
|
30-39mg/L |
Target trough level 30 – 40 mg/L. Continue with current dose. Re-check level one week later |
|
|
|
40-60mg/L |
If stable renal function – continue current dose and recheck level one week later. If deteriorating renal function – contact Micro/ID |
||
|
Greater than 60mg/L |
DO NOT give the next dose. Contact Micro/ID. |
||
DO NOT withhold further doses whilst awaiting the result. Teicoplanin assays are performed off-site in an independent laboratory. Therefore, results may take approximately two days to become available. Do not send a second sample while awaiting a result, receipt of the initial sample can be confirmed on EPR.
Other monitoring parameters
All patients should have at least weekly FBC, U&E, and LFT monitoring while treated with teicoplanin.
Monitor renal and auditory function during treatment in patients with renal impairment and/or those who are taking potentially nephrotoxic/ototoxic drugs concomitantly.
Cautions/Contraindications
Cautioned use in:
- Vancomycin allergy/sensitivity
- Renal impairment
Contraindicated in:
- Previous history or hypersensitivity to teicoplanin.
Pregnancy and breastfeeding
Pregnancy - Discuss with pharmacy. Use only if potential benefit outweighs risks (very limited data therefore use only if no safer alternative). There is a potential risk of inner ear and renal damage to the foetus.
Breastfeeding - Limited human data. Quantity of teicoplanin excreted into breastmilk is unknown but predicted to be low. Specialist Pharmacy Service states can use when breastfeeding. Monitor infant for gastro-intestinal disturbances and oral candida infection, especially if used for prolonged periods or in high doses, although these effects are unlikely to occur.
References
- Teicoplanin 200mg powder for solution for injection/infusion or oral solution [online]. Manufacturer - Bowmed Ibisqus Limited – last updated: 2023 Jun 9. Accessed via: www.emc.medicines.org.uk [Accessed 2023 Aug 24].
- The Renal Drug Database. Teicoplanin- last updated: 2019 Sep 9. Accessed via: https://renaldrugdatabase.com [Accessed 2023 Aug 23].
- Specialist Pharmacy Service – Lactation Safety Information: Teicoplanin – last updated 2017 Jun 22. Accessed via: https://www.sps.nhs.uk/medicines [Accessed 21/9/23].
- Briggs GG, Freeman RK, Towers CV, Forinash AB. Briggs Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk [online]. Lippincott Williams & Wilkins; 2021 Feb 18. Accessed via https://online.lexi.com [Accessed 2022 Nov 23].