Teicoplanin

Teicoplanin - This glycopeptide antibiotic, like vancomycin, has bactericidal activity against both aerobic and anaerobic Gram + ve bacteria: Staphylococcus aureus, including MRSA, Streptococcus spp., Listeria spp. and Clostridium spp. It is only bacteriostatic for most Enterococcus spp. It does not cause red man syndrome through histamine release and is less nephrotoxic than vancomycin. However, due to the variation between patients, effective therapeutic levels for severe infections may not be reached for a number
of days using the most commonly recommended dosage schedules. Serum monitoring of pre-dose levels is recommended, particularly for severe infections.

In the UK resistance is well recognised in enterococci and coagulasenegative staphylococci and, more worryingly, is now emerging in
S. aureus.

Uses
Serious Gram + ve infections:
• prophylaxis and treatment of infective endocarditis (usually combined with gentamicin)
• dialysis-associated peritonitis
• infection caused by MRSA
• prosthetic device infections due to coagulase-negative staphylococci
• alternative to penicillins and cephalosporins where patients are allergic

Contraindications
Hypersensitivity

Administration
IV bolus: 400 mg 12 hourly for 3 doses, then 400 mg daily. Give over 3–5 min

In obesity, use 6 mg/kg per dose (rounded to the nearest 100 mg) rather than 400mg

Reconstitute with WFI supplied. Gently roll the vial between the hands until powder is completely dissolved. Shaking the solution will cause the formation of foam. If the solution becomes foamy allow to stand for 15 min

Monitor: FBC, U&E, LFT
Serum pre-dose teicoplanin level
Pre-dose (trough) serum concentration should not be <10 mg/l For severe infections, trough serum concentration >20 mg/l is recommended. Levels are not essential for treatment In renal impairment: dose reduction not necessary until day 4, then reduce dose as below:

CC (ml/min)	Dose (mg)	Interval
20–25	400	every day
10–20	400	every 24–48 h
<10	400	every 48–72 h

How not to use teicoplanin

Do not mix teicoplanin and aminoglycosides in the same syringe

Adverse effects

Raised LFTs

Hypersensitivity

Blood disorders

Ototoxic

Nephrotoxic

Cautions

Vancomycin sensitivity

Renal/hepatic impairment

Concurrent use of ototoxic and nephrotoxic drugs

Organ failure

Renal: reduce dose

Renal replacement therapy

CVVH unknown dialysability, dose as in CC 10–20 ml/min, i.e. 400mg 12 hourly for 3 doses then 400 mg every 24–48 hours. HD/PD not dialysable, dose 400 mg 12 hourly for 3 doses then 400 mg every 48–72 hours. Can measure levels for therapy optimisation but is not

essential.