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A post-authorization survey to evaluate plasma concentrations of teicoplanin in adult hospitalized patients treated for sepsis in Gauteng, South Africa

Objective

This study measured and analyzed plasma concentrations of teicoplanin in patients >18 years in the first 4 days of administration.

Methods

This was an open-label, multicentre, observational study in patients receiving teicoplanin for suspected or diagnosed Gram-positive infection. Data collection included demographics, method of administration, loading and maintenance doses, creatinine and adverse events. Trough and peak concentrations were determined 15 minutes prior to drug administration and 60 minutes after. Serum was separated and stored at -20°C until analysis. Levels were determined with an Abbott TDx®/FLx® analyzer and Seradyn Teicoplanin Innofluor assay kits. Seradyn internal teicoplanin controls were run within and between each batch. Mean trough and peak plasma levels were calculated for 4 days of therapy.

Results

Seventy-four patients with complete records were analyzed and whilst all patients received an 800 mg loading dose on day 1, 40 received 400 mg twice daily thereafter (BD group) and 34 once daily (OD group), for nosocomial pneumonia (n = 14), skin and soft tissue infection (burn and nonburn including diabetic foot) (n = 13), bacteraemia (n = 10), intra-abdominal infection (n = 8), bone and joint infection (n = 6) and as pre-emptive therapy for severe trauma (n = 13). In the OD group, mean trough levels remained at 9.64 μg/ml from days 2 to 4 and peak levels remained at a mean of 24.84 μg/ml. In the BD group, mean trough levels increased by 5.65 μg/ml/24 hours to 21.8 μg/ml by day 4; the mean peak level increased by 5.06 μg/ml/24 hours to 43.89 μg/ml by day 4.

Conclusion

Higher trough levels of glycopeptides (15–20 μg/ml) are targeted to improve efficacy and reduce resistance development. In the OD group the conventional target of 10 μg/ml was achieved, whilst in the BD arm 20 μg/ml was exceeded for 60% of the time by day 2 and 100% by day 4. BD dosing is recommended for most patients with severe infections, particularly those that are critically ill. No premature discontinuations or adverse events were reported during the study.

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Brink, A., Richards, G. A post-authorization survey to evaluate plasma concentrations of teicoplanin in adult hospitalized patients treated for sepsis in Gauteng, South Africa. Crit Care 11, P103 (2007). https://doi.org/10.1186/cc5263

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Keywords

  • Glycopeptide
  • Peak Level
  • Teicoplanin
  • Trough Level
  • Soft Tissue Infection