Paediatric: Teicoplanin
General Information
Formulary antimicrobial: Use in accordance with Trust guidelines
This monograph relates to treatment doses of teicoplanin for patients:
- term up to 2 months
- 2 months to 12 years old.
This monograph is not for use in:
- neonatal unit
- 12 years and over (see adult guideline)
- Endophthalmitis
- Device related infections (e.g.VA-VP shunt, EVD) excluding central vascular catheters
- Surgical prophylaxis
See separate guidelines or contact Paediatric ID/Micro
Cautions and contraindications
Cautioned use in:
- Vancomycin allergy/sensitivity
- Renal impairment
Contraindicated in:
- Previous history or hypersensitivity to teicoplanin.
Intravenous dosing
Term up to 2 months:
|
Loading dose |
Maintenance dose |
|
16mg/kg STAT |
8mg/kg OD |
2 months to 11 years:
|
Loading dose |
Maintenance dose |
|
10mg/kg* (Max = 800mg) every 12 hours for three doses |
10mg/kg* (Max = 800mg) OD |
* For patients over 125kg seek advice from Paediatric Micro/ID.
12 years and over: see adult guidelines
Dose in renal and hepatic impairment
Renal impairment:
|
eGFR 30-80mL/min/1.73m2 |
Normal dose regimen on days 1–4 , then use normal maintenance dose every 48 hours |
|
eGFR less than 30mL/min/1.73m2 |
Normal dose regimen on days 1–4, and then use normal maintenance dose every 72 hours |
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. Contact an antimicrobial pharmacist if unclear
Only trough (pre-dose) levels are taken. The first trough level should be taken between 6 and 8 days of therapy.
- For Teicoplanin levels collect blood in a clotted tube (clear tube) and send to the core automated laboratory for analysis.
- Some children are old enough for adult bottles (yellow top).
- Specify the time and date of sampling on the request form.
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.
|
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 15mg/L |
Contact Paediatric micro/ID. |
||
|
15-19mg/L |
Target trough level 15 – 30 mg/L. Continue with current dose. Re-check level one week later |
||
|
20-29mg/L |
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 Paediatric micro/ID |
||
|
Greater than 60mg/L |
Do not give the next dose. Contact Paediatric micro/ID. |
||
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/neurotoxic drugs concomitantly.