Therapy with teicoplanin in the ICU: continuous intravenous infusion or intermittent intravenous administration?

Introduction

Teicoplanin is a glycopeptide antibiotic. The principle pharmacodynamic parameter is time dependency.

Methods

A total of 16 critically ill patients were enrolled into the study after informed consent. They were being treated for suspected or documented Gram-positive infections. We administrated an initial loading dose of 10 mg/kg every 12 hour for three doses, followed by a maintenance dose based on therapeutic drug monitoring and therapy personalization by Bayesian computerized software. For the maintenance dose we divided patients into two groups; in the first group teicoplanin was administrated intermittently every 24 hours (control group), in the second group by continuous infusion (study group). Adequate drug exposure was defined as a plasma level concentration >10 mg/l or greater. Blood samples for therapeutic drug monitoring were collected immediately before teicoplanin administration. When the pathogen agents were isolated, bacteriostatic and bactericidial properties of the serum were tested in both groups.

Results

No differences between groups were found regarding mortality and renal damage. In the study group we reached greater level of teicoplanin despite the same amount of drug (Figure 1). To reach an adequate plasmatic level we had to increase the amount of teicoplanin in four patients in the control group, but we halved the dose in one patient and brought it down to one-quarter in another one in the study group. Bactericidial serum activity was greater in the continuous group, although without statistical significance (Figure 1).

Figure 1

Conclusion

Our data suggest that the administration of teicoplanin by continuous intravenous infusion compared with the intermittent mode might be more efficient in critically ill patients.