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# Targocid (Teicoplanin) ## Overview Targocid (teicoplanin) is a glycopeptide antibiotic used primarily for serious Gram-positive bacterial infections, including those caused by methicillin-resistant *Staphylococcus aureus* (MRSA). It inhibits bacterial cell wall synthesis. ## Primary Indications * Serious Gram-positive bacterial infections, including: * Skin and soft tissue infections * Bone and joint infections * Pneumonia * Endocarditis * Bacteremia * Infections in patients who cannot take or have failed beta-lactam antibiotics. * Treatment of prosthetic device infections. ## Adult Dosing **Loading Dose:** * **Intravenous (IV) or Intramuscular (IM):** 12 mg/kg once daily for 3 doses, given on days 1, 2, and 3. * **IV Continuous Infusion:** An alternative loading regimen is 400 mg IV every 12 hours for 3 doses. **Maintenance Dose:** * **IV or IM:** 6 mg/kg once daily, usually initiated on day 4. * **Severe infections (e.g., endocarditis, osteomyelitis):** May require higher doses, up to 12 mg/kg once daily. Maximum daily dose is generally 1.2 grams. **Note:** Specific dosing may depend on local protocols and the severity of infection. ## Pediatric Dosing **Neonates (0-2 months):** * **Loading Dose:** 16 mg/kg IV once daily on days 1, 2, and 3. * **Maintenance Dose:** 8 mg/kg IV once daily beginning on day 4. **Children (2 months to 12 years):** * **Loading Dose:** 10-20 mg/kg IV or IM once daily for 3 doses. * **Maintenance Dose:** 10 mg/kg IV or IM once daily. * **Severe infections:** May require up to 20 mg/kg/day. **Adolescents (12 years and older):** Use adult dosing. ## Dose Adjustments * **Renal Impairment:** * Mild to moderate impairment: Loading doses are the same. Maintenance dose can be halved or given every 48 hours. * Severe impairment/Hemodialysis: Loading doses are the same. Maintenance dose is typically 1.5 mg/kg every 48 hours or 1 mg/kg daily. Monitor trough levels. * **Hepatic Impairment:** No specific dose adjustment, but monitor liver function. ## Contraindications * Known hypersensitivity to teicoplanin or other glycopeptide antibiotics. * Use with neuromuscular blocking agents (may potentiate neuromuscular blockade). ## Adverse Effects * **Common:** Infusion site reactions (pain, phlebitis), rash, fever, eosinophilia, leukopenia, thrombocytopenia, elevated liver enzymes. * **Serious:** Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), anaphylaxis, nephrotoxicity, ototoxicity (less common than with vancomycin), pseudomembranous colitis. * **Red Man Syndrome:** Similar to vancomycin, characterized by flushing and pruritus, usually related to rapid IV infusion. ## Key Drug Interactions * **Aminoglycosides:** Additive nephrotoxicity and ototoxicity. * **Amphotericin B:** Additive nephrotoxicity. * **Loop Diuretics:** Increased risk of nephrotoxicity. * **Neuromuscular Blocking Agents:** Potential for enhanced neuromuscular blockade; requires careful monitoring. ## Monitoring * **Trough serum teicoplanin concentrations:** Crucial for ensuring efficacy and minimizing toxicity, especially in patients with renal impairment, severe infections, or suspected therapeutic failure. Target trough levels generally range from 10-20 mcg/mL, but vary by indication and pathogen. * **Renal function:** Monitor serum creatinine and BUN regularly. * **Liver function:** Monitor liver enzymes. * **Complete blood count (CBC):** Monitor for hematologic effects. * **Culture and sensitivity:** To guide therapy and assess for resistance. * **Hearing:** Baseline and periodic audiometry if risk factors for ototoxicity are present. ## Clinical Pearls * Teicoplanin has a longer half-life than vancomycin, allowing for once-daily dosing (except for initial loading phase). * It is administered intravenously or intramuscularly. IM administration can be painful. * Trough levels are essential for optimizing therapy and safe use, especially in specific patient populations. * The risk of nephrotoxicity and ototoxicity is generally considered lower with teicoplanin compared to vancomycin, but still requires vigilant monitoring. * Always reconstitute and dilute according to manufacturer instructions. *** **Disclaimer:** This information is intended for educational purposes for healthcare professionals. Always refer to the most current official prescribing information and consult with relevant literature or experts for definitive clinical decisions. Drug information can change rapidly.