title: Teicoplanin levels in bone and joint infections: are standard doses subtherapeutic?
abstract: OBJECTIVE
  Previously published data suggest that a trough serum teicoplanin level of > or = 20 mg/l is predictive of improved outcomes in serious staphylococcal infection. We investigated how dose regimen and patient characteristics impact on trough teicoplanin levels in patients with musculoskeletal infection, in order to help standardise teicoplanin use.
  
  
  METHODS
  We prospectively collected data for 141 clinically stable adults with bone and joint infection treated as outpatients with teicoplanin. Patients with end stage renal failure were excluded.
  
  
  RESULTS
  The most frequently used teicoplanin dose regimens were 400 mg or 600 mg i.v. once daily. Trough levels were available for 78% of episodes, of which 51% were > or = 20 mg/l. Unsurprisingly, a level of > or = 20 mg/l occurred more often with a dose of 600 mg than with lower doses (p=0.005). There was no significant relationship between teicoplanin level and age, body weight or creatinine clearance, but male gender was associated with lower trough levels than female gender (p=0.03).
  
  
  CONCLUSIONS
  These data suggest that teicoplanin levels of > or = 20 mg/l for bone and joint infection in stable adult patients are best achieved with a daily dose of at least 600 mg.
authors.affiliation: Department of Infectious Diseases and Microbiology, John Radcliffe Hospital, Oxford Radcliffe Hospitals NHS Trust, Headley Way, Headington, Oxford, OX3 9DU, UK. p.matthews@doctors.org.uk
authors.forename: Philippa C
authors.initials: PC
authors.lastname: Matthews
authors.forename: Alison
authors.initials: A
authors.lastname: Taylor
authors.forename: Ivor
authors.initials: I
authors.lastname: Byren
authors.forename: Bridget L
authors.initials: BL
authors.lastname: Atkins
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use*; D001168:Arthritis / Q000188:drug therapy* / Q000382:microbiology; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D001835:Body Weight; D003404:Creatinine / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D010000:Osteitis / Q000188:drug therapy* / Q000382:microbiology; D010045:Outpatients; D012189:Retrospective Studies; D012737:Sex Factors; D017334:Teicoplanin / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use*