Recommendations to achieve rapid therapeutic teicoplanin plasma concentrations in adult hospitalised patients treated for sepsis

The optimum teicoplanin loading dose and duration of therapy required for rapid attainment of a therapeutic trough plasma concentration (Cmin) (≥10 mg/L for serious Gram-positive infections and ≥20 mg/L for deep-seated infections) are not known. In this open-label, multicentre, observational study, teicoplanin levels were determined following administration of loading doses of 6 mg/kg every 12 h on Day 1 followed by 6 mg/kg once or twice daily to hospitalised patients with suspected or diagnosed Gram-positive infections. Cmin levels for the first 4 days of treatment were collected 15 min prior to drug administration. Levels were determined with an Abbott TDx®/FLx® Analyzer and Seradyn Teicoplanin Innofluor Assay Kit. The two target trough values (≥10 mg/L and ≥20 mg/L) were only achieved by Day 4 in the once-daily group (n = 34; mean 9.55 mg/L, 95% confidence interval (CI) 8.17–10.94 mg/L) and in the twice-daily group (n = 40; mean 21.8 mg/L, 95% CI 17.21–26.39 mg/L), respectively. However, the mean Cmin in the twice-daily group was ≥10 mg/L (11.03 mg/L) by Day 2. To achieve rapid therapeutic Cmin concentrations targeted for the majority of serious Gram-positive infections, we recommend teicoplanin loading doses of 6 mg/kg every 12 h for 48 h followed by once-daily for infections other than infective endocarditis, septic arthritis and osteomyelitis. Regarding the latter infections, higher loading doses might be warranted to reach rapid steady-state concentrations.