Pharmacokinetics of teicoplanin during plasma exchange

Abstract

Objective: To study the elimination of teicoplanin during plasma exchange, a procedure currently used to treat a variety of disorders involving immune complexes. Teicoplanin is a glycopeptide antibiotic that exhibits a long terminal half-life (100-150 h) and is highly bound to plasma proteins (unbound fraction (f(u)) = 0.2). Methods: Twelve adults with systemic polyarteritis nodosa, cryoglobulinemia-induced vasculitis or dysglobulinemic neuropathy undergoing plasma exchange were studied. Each patient received intravenous teicoplanin, 6 mg/kg body weight, immediately before plasma exchange. Plasma was assayed for teicoplanin by high-pressure liquid chromatography. Results: A high level of protein binding of teicoplanin was measured within this patient population (98%). The mean quantity of teicoplanin eliminated (± SD) was 74.6 ± 34.6 mg. The mean drug fraction eliminated by plasma exchange (± SD) was 19.5 ± 5.6%. Mean f(u) value as determined by ultrafiltration (± SD) was 2.2 ± 1.7%. Conclusions: These results show that plasma exchange influences teicoplanin pharmacokinetics, with a clinically significant quantity being eliminated. If trough teicoplanin concentrations of around 10 mg/L are desired, it is recommended that teicoplanin dosage be supplemented or given after plasma exchange.