Loading Dose Required to Achieve Rapid Therapeutic Teicoplanin Trough Plasma Concentration in Patients with Multidrug-Resistant Gram-Positive Infections

Abstract

Teicoplanin is an antibiotic drug prescribed for the treatment of multidrug-resistant Gram-positive infections. However, there is currently no consensus as to the optimal teicoplanin loading dose. The objective of this study was to compare plasma concentrations of teicoplanin in patients with multidrug-resistant Gram-positive infections after the administration of two different loading doses. Two groups of patients were infused intravenously with four loading doses of 6 mg/kg body-weight (group A, n = 12) or 12 mg/kg body-weight (group B, n = 11). The first three loading doses were administered at 12-hr intervals, and the fourth was given 24 hr after the third dose. Maintenance doses of 6 mg/kg were administered every day, every other day or every third day depending on the individual's creatinine clearance, and teicoplanin trough plasma concentrations were monitored. Only samples obtained on the same day for both groups were compared statistically. A higher percentage of group B patients achieved the desired therapeutic concentration of teicoplanin (C min. ≥ 10 mg/L) on days 2 and 3 (90.0% and 100%, respectively) compared with patients in group A (18.2% and 16.7%, respectively) (p < 0.001). In addition, more patients in group B achieved therapeutic concentrations from days 2 through 12. In conclusion, despite limitations in drawing definitive conclusions because of a relatively small sample size and variability in renal impairment among patients, our findings suggest that a teicoplanin loading dose of 12 mg/kg body-weight results in a safe and rapid attainment of therapeutic trough plasma concentrations. This regimen may enhance treatment efficacy. © 2012 The Authors. Basic & Clinical Pharmacology & Toxicology © 2012 Nordic Pharmacological Society.