Teicoplanin

# Teicoplanin ## Overview - **Classification**: Glycopeptide antibiotic. - **Mechanism**: Inhibits bacterial cell wall synthesis by binding to D-Ala-D-Ala, preventing peptidoglycan polymerization. Bactericidal. ## Primary Indications 1. **Serious Gram-positive infections**: Including MRSA, CoNS. 2. **Endocarditis**: Due to susceptible Gram-positive organisms. 3. **Bone and joint infections**: Such as osteomyelitis. 4. **Catheter-related infections**: Caused by Gram-positive bacteria. 5. **Clostridioides difficile-associated diarrhea (CDAD)**: Oral formulation only. ## Adult Dosing ### Standard Dosing **Most Serious Gram-Positive Infections (IV)** - **Loading Dose**: **6 mg/kg** every 12 hours for 3 doses (total 3 doses). - **Maintenance Dose**: **6 mg/kg** once daily. - **Route**: IV infusion over 30 minutes. - **Duration**: Varies by infection, typically 7-14 days or longer. **Less Severe/Uncomplicated Infections (IV)** - **Loading Dose**: **3 mg/kg** every 12 hours for 3 doses. - **Maintenance Dose**: **6 mg/kg** once daily. - **Route**: IV infusion over 30 minutes. **Clostridioides difficile-associated diarrhea (Oral)** - **Dose**: **100-200 mg** once daily. - **Frequency**: Once daily. - **Route**: Oral solution (diluted IV powder). - **Duration**: 7-14 days. ### Dose Adjustments - **Renal Impairment**: Requires significant adjustment after initial loading doses. - CrCl 40-60 mL/min: Maintenance every 2 days. - CrCl <40 mL/min: Maintenance every 3 days. - Hemodialysis: Administer after dialysis. - **Hepatic Impairment**: No specific adjustments; use with caution. - **Elderly Patients**: Adjust based on renal function, as age often correlates with decreased CrCl. ## Pediatric Dosing ### Neonates (0-28 days) - **Loading Dose**: **16 mg/kg** as a single dose. - **Frequency**: One dose. - **Maintenance Dose**: **8 mg/kg** once daily from day 2. - **Maximum**: **8 mg/kg/day**. - **Special Notes**: Infuse slowly over 30 minutes. Monitor serum levels. ### Infants (1-12 months) - **Loading Dose**: **10 mg/kg** every 12 hours for 3 doses. - **Frequency**: Every 12 hours for 3 doses. - **Maintenance Dose**: **10 mg/kg** once daily from day 4. - **Maximum**: **10 mg/kg/day**. ### Children (1-12 years) - **Loading Dose**: **10 mg/kg** every 12 hours for 3 doses. - **Frequency**: Every 12 hours for 3 doses. - **Maintenance Dose**: **10 mg/kg** once daily from day 4. - **Maximum**: Typically capped at **adult daily maximum** (e.g., 600-800 mg). ### Adolescents (13-18 years) - **Dose**: Generally follows **adult dosing** guidelines. - **Maximum**: **Adult maximum dose** (e.g., **600-800 mg** once daily). ## Safety Information ### Contraindications - **Absolute**: Hypersensitivity to teicoplanin. - **Absolute**: Hypersensitivity to other glycopeptides (e.g., vancomycin), cross-reactivity possible. ### Common Adverse Effects - **Common (1-10%)**: Rash, pruritus, fever, injection site reactions, elevated liver enzymes. - **Uncommon (0.1-1%)**: Nausea, vomiting, diarrhea, dizziness, headache. - **Rare (<0.1%)**: Nephrotoxicity (reversible), ototoxicity (reversible), Red Man Syndrome. - **Serious but Rare**: Anaphylaxis, agranulocytosis, thrombocytopenia, severe cutaneous reactions (SJS, TEN). ### Key Drug Interactions - **Aminoglycosides (e.g., Gentamicin)**: Increased risk of nephrotoxicity and ototoxicity. Monitor renal function and hearing. - **Amphotericin B, Cyclosporine, Furosemide**: May enhance nephrotoxicity. Use with caution. - **Neuromuscular Blockers**: May potentiate effects. Monitor for prolonged paralysis. ## Monitoring & Follow-up - **Before Treatment**: Baseline renal function (SCr, eGFR/CrCl), audiometry (if pre-existing hearing loss). - **During Treatment**: - **Serum Teicoplanin Levels**: Trough levels are crucial. - Target for most infections: **10-20 mg/L**. - Target for severe/complicated infections: **>20 mg/L**. - **Renal Function**: Daily/every other day initially, then less frequently. - **CBC**: Weekly for prolonged therapy (monitor for myelosuppression). - **Clinical Signs**: Monitor for rash, fever, changes in urine output, hearing/vestibular changes. ## Clinical Pearls - 💡 **Tip 1**: Teicoplanin generally has a **lower incidence of nephrotoxicity and "Red Man Syndrome"** compared to vancomycin. - 💡 **Tip 2**: **Therapeutic Drug Monitoring (TDM)** is essential for efficacy and safety, especially in severe infections, renal impairment, or critical illness. - 💡 **Tip 3**: Administer IV infusion **slowly over 30 minutes** to minimize infusion-related reactions. - 💡 **Tip 4**: Oral teicoplanin is **not absorbed systemically** and is used *only* for C. difficile infection. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.