title: The persistence of drug-induced fever by teicoplanin--a case report.
abstract: OBJECTIVE
  It was reported that the drug-induced fever of teicoplanin tended to persist after cessation of treatment. It is considered that the long half-life of teicoplanin causes the phenomenon. However there was no detailed report regarding plasma concentration of teicoplanin during onset of drug induced-fever. Therefore we investigated the relation between persistence of drug-induced fever and plasma concentration of teicoplanin.
  
  
  METHODS
  A 38-year-old male patient on the Left Ventricular Assist System (LVAS) was treated with teicoplanin for methicillin-resistant Staphylococcus aureus (MRSA) and he experienced drug-induced fever. Plasma concentrations of teicoplanin were measured not only during the treatment with the drug but also after it was discontinued. As such, plasma concentration was measured even when the fever had subsided.
  
  
  RESULTS
  On Day 9 of treatment, the dose was increased from 400 to 600 mg, but the patient had a fever of about 38 - 39 °C. When the treatment was discontinued, it took 9 days for the fever to subside to a temperature of about 37 °C. The half-life of elimination of teicoplanin in the elimination phase is about 108 h, which is long. The fever persisted until the plasma concentration decreased to below 10 µg/ml, which is the effective trough concentration, and subsided when the estimated blood concentration was 7.5 µg/ml.
  
  
  CONCLUSIONS
  We suggest that there is the possibility that the drug-induced fever due to teicoplanin persisted until the plasma concentration had decreased adequately. Close monitoring of plasma concentration is necessary, particularly when teicoplanin clearance is decreased such as in patients with renal dysfunction.
authors.affiliation: Departments of Pharmacy, National Cardiovascular Center, Osaka, Japan. ochih@hsp.ncvc.go.jp
authors.forename: H
authors.initials: H
authors.lastname: Ochi
authors.forename: K
authors.initials: K
authors.lastname: Wada
authors.forename: H
authors.initials: H
authors.lastname: Okada
authors.forename: N
authors.initials: N
authors.lastname: Kohara
authors.forename: T
authors.initials: T
authors.lastname: Fujita
authors.forename: K
authors.initials: K
authors.lastname: Toda
authors.forename: M
authors.initials: M
authors.lastname: Sakamoto
authors.forename: O
authors.initials: O
authors.lastname: Seguchi
authors.forename: Y
authors.initials: Y
authors.lastname: Murata
authors.forename: M
authors.initials: M
authors.lastname: Yanase
authors.forename: T
authors.initials: T
authors.lastname: Nakatani
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000493:pharmacokinetics; D058633:Antipyretics / Q000627:therapeutic use; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000628:therapy; D005334:Fever / Q000139:chemically induced* / Q000188:drug therapy; D006207:Half-Life; D006353:Heart-Assist Devices; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D010976:Platelet Count; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy; D017334:Teicoplanin / Q000009:adverse effects* / Q000493:pharmacokinetics
chemical_list: D000900:Anti-Bacterial Agents; D058633:Antipyretics; D000082:Acetaminophen; D017334:Teicoplanin