title: Age- and gender-related differences in teicoplanin levels in paediatric patients.
abstract: OBJECTIVE
  Teicoplanin is a glycopeptide antibiotic active against Gram-positive bacteria, including methicillin-resistant staphylococci. While teicoplanin trough levels (TTLs) >10 mg/L are commonly considered appropriate, levels >20 mg/L are aimed for in the treatment of severe infections. Due to toxicity, it is recommended to avoid levels >60 mg/L.
  
  
  METHODS
  In our institution, the initial dosing schedule of teicoplanin (10-15 mg/kg every 12 h for three loading doses and every 24 h thereafter) is adapted according to TTLs analysed by a fluorescence polarization immunoassay on treatment days 2 to 4. Teicoplanin peak levels (TPLs) are analysed in selected cases 30 min after the end of infusion. In a retrospective analysis we evaluated 1357 TTLs and 333 TPLs from 410 treatment episodes from 2005 to 2011.
  
  
  RESULTS
  Initial TTLs were <10 mg/L in 14.1% and <20 mg/L in 72.6% of episodes. Toddlers had significantly lower TTLs, with a 2-fold and 2.5-fold increased risk of having levels <10 mg/L (24.6%) and <20 mg/L (82.6%), respectively. For the entire cohort, follow-up TTLs were less likely to be <10 mg/L and more likely to be >20 mg/L when compared with initial TTLs (P < 0.001, each). Adolescent girls had significantly higher initial TPLs (P = 0.001) and significantly higher follow-up TTLs (P = 0.016) than adolescent boys. In parallel, adolescent girls had initial TPLs >60 mg/L significantly more frequently (P = 0.012) and follow-up TTLs <10 mg/L significantly less frequently (P = 0.005).
  
  
  CONCLUSIONS
  More tailored dosing regimens with higher loading doses, especially for toddlers, should be considered. While further pharmacokinetic data in paediatric patients are pending, therapeutic drug monitoring is mandatory.
authors.affiliation: Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Volker
authors.initials: V
authors.lastname: Strenger
authors.forename: Nora
authors.initials: N
authors.lastname: Hofer
authors.forename: Siegfried
authors.initials: S
authors.lastname: Rödl
authors.forename: Martin
authors.initials: M
authors.lastname: Hönigl
authors.forename: Reinhard
authors.initials: R
authors.lastname: Raggam
authors.forename: Markus G
authors.initials: MG
authors.lastname: Seidel
authors.forename: Hans Jürgen
authors.initials: HJ
authors.lastname: Dornbusch
authors.forename: Daniela
authors.initials: D
authors.lastname: Sperl
authors.forename: Herwig
authors.initials: H
authors.lastname: Lackner
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schwinger
authors.forename: Petra
authors.initials: P
authors.lastname: Sovinz
authors.forename: Martin
authors.initials: M
authors.lastname: Benesch
authors.forename: Berndt
authors.initials: B
authors.lastname: Urlesberger
authors.forename: Christian
authors.initials: C
authors.lastname: Urban
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000097:blood* / Q000493:pharmacokinetics*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012737:Sex Factors; D017334:Teicoplanin / Q000008:administration & dosage / Q000097:blood* / Q000493:pharmacokinetics*
chemical_list: D000900:Anti-Bacterial Agents; D017334:Teicoplanin
keywords: glycopeptides; pharmacokinetics; therapeutic drug monitoring