title: Pharmacokinetics of teicoplanin in an ICU population of children and infants.
abstract: OBJECTIVE
  Better dosing is needed for antibiotics, including teicoplanin (TEI), to prevent emergence of resistant bacterial strains. Here, we assess the TEI pharmacokinetics (PK) related to a 10 mg/l minimum inhibitory concentration (MIC) target in ICU children (4 to 120 months; n = 20) with gram+ infections.
  
  
  METHODS
  Standard administration of TEI was with three 10 mg/kg Q12h, loading infusions, and maintainance with 10 mg/kg or 15 mg/kg Q24h. During maintenance, 9 samples (3/day) were collected per patient and the PK analyzed with Nonlinear Mixed Effects Model (NONMEM).
  
  
  RESULTS
  Thirty-five percent of concentrations in older children (> or =2 months) vs. 8% in younger infants (<12 months) were below the target MIC. The global bicompartmental population PK parameters were [mean (interindividual CV%)] CL = 0.23 l/h [72%], V = 3.16 l [58%], k12 = 0.23 h(-1), and k21 = 0.04 h(-1). Two PK subpopulations were identified. The older children had CL = 0.29 [23%] l/h, V = 3.9 l and the younger infants, CL = 0.09 [37%] l/h, V = 1.05 l. Residual error was reduced from 52% to around 30% in the final models.
  
  
  CONCLUSIONS
  Older children in the ICU may require relatively higher doses of teicoplanin. However, a study in a larger population is needed.
authors.affiliation: Laboratory of Biopharmaceutics and Pharmacokinetics, School of Pharmacy, University of Athens, Zografou 15771, Athens, Greece. jlukas@ath.forthnet.gr
authors.forename: John C
authors.initials: JC
authors.lastname: Lukas
authors.forename: Georgios
authors.initials: G
authors.lastname: Karikas
authors.forename: Maria
authors.initials: M
authors.lastname: Gazouli
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kalabalikis
authors.forename: Tasos
authors.initials: T
authors.lastname: Hatzis
authors.forename: Panos
authors.initials: P
authors.lastname: Macheras
mesh_terms: D000375:Aging / Q000378:metabolism; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics*; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D005260:Female; D016231:Fluorescence Polarization Immunoassay; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D008297:Male; D015233:Models, Statistical; D009010:Monte Carlo Method; D011153:Population; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000382:microbiology; D017334:Teicoplanin / Q000493:pharmacokinetics*
chemical_list: D000900:Anti-Bacterial Agents; D017334:Teicoplanin