Development of teicoplanin dosage guidelines for patients treated within an outpatient parenteral antibiotic therapy (OPAT) programme.
OBJECTIVE
The long elimination half-life of teicoplanin facilitates outpatient parenteral antibiotic therapy (OPAT) with thrice-weekly dosing. This study aimed to develop teicoplanin dosage guidelines for OPAT use from routine clinical data.


METHODS
Patients received 15-25 mg/kg/day for 3 days, then 15-25 mg/kg thrice weekly. Trough concentrations were measured weekly and doses adjusted to maintain 20-30 or 10-20 mg/L according to clinical condition. Concentration-time data were analysed using the pharmacokinetic package NONMEM and the final model was used to develop new dosage guidelines.


RESULTS
Data from 94 and 36 patients were used for model development and validation, respectively. Patient ages ranged from 15 to 94 years, weights from 43 to 146 kg and estimated CL(CR) from 9 to 195 mL/min. Teicoplanin concentrations (n = 670) ranged from 6.7 to 66.9 mg/L and a one-compartment model adequately described the data. The typical estimate of CL was 0.542 L/h and changed by 10.6% for every 10 mL/min difference from a CL(CR) of 66 mL/min. V was 1.62 L/kg. Dosage guidelines based on body weight and CL(CR) can be expected to lead to a significant improvement in the proportion of concentrations in the range 20-30 mg/L. Alternative doses aimed at lower target concentrations have also been developed.


CONCLUSIONS
New dosage guidelines have been developed to support thrice-weekly administration of teicoplanin in an OPAT setting.
Pharmacy Department, Gartnavel General Hospital, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK.
Elspeth
E
Lamont
R Andrew
RA
Seaton
Merran
M
Macpherson
Lindsay
L
Semple
Emma
E
Bell
Alison H
AH
Thomson
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D001424:Bacterial Infections / Q000188:drug therapy*; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010949:Plasma / Q000737:chemistry; D017334:Teicoplanin / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D055815:Young Adult
D000900:Anti-Bacterial Agents; D017334:Teicoplanin