title: Increased teicoplanin doses are associated with improved serum levels but not drug toxicity.
abstract: OBJECTIVE
  Teicoplanin is widely used for the treatment of severe gram-positive infection, aiming to achieve trough serum levels of 20-60 mg/L for patients with severe infection. A standard 400 mg daily dose is frequently associated with sub-therapeutic levels, and we have therefore changed our routine approach to 600 mg daily (following loading doses in each case). We set out to investigate the impact of this dose increase on drug levels and potential side-effects.
  
  
  METHODS
  We undertook a retrospective study of 549 consecutive adult Out-Patient Antimicrobial Treatment (OPAT) episodes treated with intravenous teicoplanin.
  
  
  RESULTS
  Therapeutic teicoplanin levels were more frequently achieved in patients treated with 600 mg compared to 400 mg daily (68% vs. 37% respectively, p < 0.0001), without an increased frequency of potentially toxic levels, defined as >60 mg/L (6% vs. 8% respectively, p = 0.4). There was no difference in the incidence of neutropaenia, eosinophilia, thrombocytopaenia, acute renal injury or treatment cessation in patients treated with the higher teicoplanin dose.
  
  
  CONCLUSIONS
  In the majority of stable adult patients with normal renal function, we advocate a loading regimen (600 mg b.d. for two doses) followed by a 600 mg daily teicoplanin dose in order to achieve therapeutic trough levels.
authors.affiliation: Oxford Bone Infection Unit, Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7HE, UK; Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK; Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, South Parks Road, Oxford OX1 3SY, UK. Electronic address: p.matthews@doctors.org.uk.
authors.forename: Philippa C
authors.initials: PC
authors.lastname: Matthews
authors.forename: Amy L
authors.initials: AL
authors.lastname: Chue
authors.forename: David
authors.initials: D
authors.lastname: Wyllie
authors.forename: Adam
authors.initials: A
authors.lastname: Barnett
authors.forename: Tomide
authors.initials: T
authors.lastname: Isinkaye
authors.forename: Lorrayne
authors.initials: L
authors.lastname: Jefferies
authors.forename: Andrew
authors.initials: A
authors.lastname: Lovering
authors.forename: Matthew
authors.initials: M
authors.lastname: Scarborough
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood* / Q000493:pharmacokinetics; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000097:blood* / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017334:Teicoplanin / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood* / Q000493:pharmacokinetics; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D017334:Teicoplanin
keywords: Adverse effects; Glycopeptides; OPAT; Osteomyelitis therapy; Therapeutic drug monitoring