Teicoplanin antimicrobial prescribing guidance for Adult Patients

Publication: 11/09/2017  
Next review: 07/07/2025  
Clinical Guideline
CURRENT 
ID: 5154 
Approved By: Improving Antimicrobial Prescribing Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2022  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

TEICOPLANIN ANTIMICROBIAL PRESCRIBING GUIDANCE for Adult patients

Teicoplanin is a protected antimicrobial and classed as a partially restricted. It can be prescribed without a code if mentioned in a guideline; in all other circumstances a code is required from an Infection Specialist.

Please refer to the BNF or the Summary of Product Characteristics (SPC) for information on:

  • Pharmacokinetics
  • Interactions
  • Side effects
  • Allergy information
  • Use in Breastfeeding and pregnancy

DRUG INFORMATION

Class of antimicrobial: Glycopeptide

Antimicrobial spectrum: bactericidal activity against aerobic and anaerobic Gram-positive bacteria including multi-resistant staphylococci. However, there are reports of Staphylococcus aureus with reduced susceptibility to glycopeptides and increasing reports of glycopeptide-resistant enterococci.

Elimination half-life: varies from 100 to 170 hours.

Allergy advice: Contraindication with hypersensitivity to teicoplanin or to any excipients.
Caution should be taken if there has been previous hypersensitivity reported with vancomycin due to the risk of cross-sensitivity between the two agents. However, if “red-man syndrome” has previously been reported with vancomycin, teicoplanin can still be used with caution. If such a reaction occurs, teicoplanin should be stopped immediately and appropriate emergency measures taken.

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ADMINISTRATION

Teicoplanin can be administered intramuscularly and intravenously for a systemic infection (as a bolus for doses <800mg or as an infusion for doses >800mg.)

In rare cases (even at the first dose), red man syndrome has been observed.  Stopping or slowing the infusion may result in cessation of these reactions. Infusion related reactions can be limited if the daily dose is administered as an infusion rather than a bolus.

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INDICATIONS AND DOSING - For dosing in critical care patients see Appendix 1.

The dose is based on actual body weight. Maximum of 2g per single dose.

The dose should be rounded up or down to the nearest 100mg to allow straightforward administration.

Indication

Dose

Target level

GO TO APPENDIX 1 FOR DOSING IN CRITICAL CARE PATIENTS

Infective endocarditis

12mg/kg

30-40mg/L

  • Bone and joint including osteomyelitis and septic arthritis
  • Bacteraemias
  • Diabetic Foot Infections
  • Infected central venous catheters (CVCs)
  • Infected long term intravascular access devices
  • Spontaneous bacterial peritonitis
  • Infected parapneumonic effusions and empyemas
  • Intra-abdominal sepsis
  • Neutropenic sepsis

12mg/kg

20-30mg/L

  • Skin and soft tissue including cellulitis, breast abscesses and mastitis
  • Pneumonia (community, hospital and

ventilator acquired and aspiration )

  • Exacerbations of cystic fibrosis
  • Parotitis Sinusitis
  • Otitis externa, media and and mastoiditis
  • Tonsillar pharyngitis and epiglottitis

6mg/kg

 

 

15-30mg/L

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RENAL IMPAIRMENT DOSING

Usual Dosage in adults

Loading dose

Maintenance dose

Dose (as above) every 12 hours for 3 doses followed by 12mg/kg once daily until day 5

Frequency according to renal function stated below

Renal Function

Creatinine clearance (CrCL mL/minute)

Dose adjustment from the 5th day on wards

Example
12mg/kg dosing based on a 70kg patient

Example 6mg/kg dosing based on a 70kg patient

>80

No dose adjustment required

800mg once daily

400mg once daily

30-80

Dose should be omitted on alternate days i.e. from day 5

800mg alternate days (i.e every 48 hours)

400mg alternate days (i.e. every 48 hours)

<30 or peritoneal dialysis

Dose should be administered every 72 hours i.e. omitted on day 5 & 6

800mg every 72 hours

400mg every 72 hours

Intermittent dialysis

1/3 of the dose administered daily

300mg once daily

150mg once daily

 

CVVHD

Dose should be omitted on alternate days i.e. from day 5

800mg alternate days (i.e every 48 hours)

400mg alternate days (i.e. every 48 hours) Note this dose should only be continued if level is in range.

Teicoplanin requires dose reduction in renal impairment. Creatinine clearance (CrCl) using the Cockcroft and Gault calculation should be calculated and eGFR should not be used: https://www.mdcalc.com/creatinine-clearance-cockcroft-gault-equation .

  • Use Ideal body weight (IBW) to calculate CrCl if a patient is overweight
  • If actual body weight is more than 25% greater than their IBW use adjusted body weight to calculate CrCl.

Patients receiving dialysis at Leeds are not suitable for 72 hour dosing due to the increased clearance of teicoplanin in HDF / Hi-Flux dialysis therefore resulting in subtherapeutic drug levels when dialysis and teicoplanin dosing times do not coincide.

To avoid this, it is advised that the maintenance dose of teicoplanin is reduced as documented in the table above (rounded to the nearest 50mg). On dialysis days the dose should be administered post dialysis.

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THERAPEUTIC DRUG MONITORING (TDM)

  • Levels only need to be monitored in patients who are being treated for more than seven days.
  • Trough levels should be taken just before the dose is administered.
  • Take the initial level before the dose on the fifth day.
  • If the dose has been reduced to alternate days, or every 72 hours, take the level before the first dose of this change.
  • Levels that are in range should be monitored weekly.
  • When dose adjustments have been made due to plasma concentration levels being out of range, take the level on the fifth day after this change.

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Dosing

Level below target range

Target levels (mg/L)

Level above target range

12mg/kg OD

<20mg/L: increase dose by 50%
If 20-30mg/L: increase dose by 25%

30-40

40-60mg/L: reduce by 25%
>60mg/L: consider reducing by 50% and discuss with antimicrobial pharmacist

<20mg/L: increase dose by 50%

20-30

30-40mg/L: no action unless adverse effects are reported/renal function deteriorates.
>40mg/L: reduce
40-60mg/L: reduce by 25%
>60mg/L: consider reducing by 50% or withholding doses and discussing with an antimicrobial pharmacist

6mg/kg OD

<15mg/L: increase dose by 50%

15-30

30-40mg/L: no action unless adverse effects are reported/renal function deteriorates.
>40mg/L: reduce
40-60mg/L: reduce by 25%
>60mg/L: consider reducing by 50% or withholding doses and discussing with an antimicrobial pharmacist

 

FURTHER MONITORING

Severe bullous reactions: if symptoms or signs of Stevens-Johnson syndrome (SJS) or Toxic Epidermal Necrolysis (TEN) (e.g. progressive skin rash often with blisters or mucosal lesions) are present teicoplanin treatment should be discontinued immediately.

Nephrotoxicity and otoxoxicity: deafness and tinnitus has been reported in patients treated with teicoplanin. Patients should be carefully evaluated and monitored, especially in cases of prolonged treatment and renal insufficiency. If receiving other medicines with known neurotoxic/ototoxic potential, patients should be carefully monitored with regular haematology, liver and kidney function test; the benefit of teicoplanin evaluated if hearing deteriorates.

Thrombocytopenia: periodic haematological examinations are recommended during treatment, including complete full blood count.

Any suspected adverse reactions should be reported via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard.

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DISCHARGE INFORMATION

The Outpatient Parenteral Antimicrobial Therapy (OPAT) service can support with discharging patients requiring teicoplanin. Please refer to the OPAT/CIVAS team. The OPAT drug monographs includes all of the information required for administration, reconstitution and supply at discharge.

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Provenance

Record: 5154
Objective:
Clinical condition:
Target patient group: Adults
Target professional group(s): Pharmacists
Secondary Care Doctors
Adapted from:

Evidence base

  • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press [Accessed on 11th May 2021]
  • Sanofi (2020) Targocid 400mg powder for solution for injection/infusion or oral solution SmPC. Available at: https://www.medicines.org.uk/emc/product/2927/smpc#gref (Accessed: 11th May 2021).

Approved By

Improving Antimicrobial Prescribing Group

Document history

LHP version 3.0

Related information

Appendix 1 - INDICATIONS AND DOSING FOR CRITICAL CARE PATIENTS

All patients (level 2 and 3) who are being treated with teicoplanin in critical care require 12mg/kg dosing. A longer loading dose period may be required depending on indication, as per the table below.

If a patient is already prescribed teicoplanin and then is transferred to critical care, the dose of teicoplanin should be adjusted to 12mg/kg unless their level is already in range. If a patient is on teicoplanin and the level is not in the required range or they are still in the loading period, the patient should be re-loaded as per the guidance below. Daily monitoring of renal function should be undertaken.

If a patient is stepped down from critical care to a base ward and their infection has improved, continue to monitor levels and adjust the dose accordingly.

The dose is based on actual body weight. Maximum of 2g per single dose.

The dose should be rounded up or down to the nearest 100mg to allow straightforward administration.

Indication

Loading Dose

Maintenance Dose

Target level

Infective endocarditis

5 loading doses of 12mg/kg

12mg/kg

30-40mg/L

  • Bone and joint including osteomyelitis and septic arthritis
  • Bacteraemias
  • Diabetic Foot Infections
  • Infected central venous catheters (CVCs)
  • Infected long term intravascular access devices
  • Spontaneous bacterial peritonitis
  • Infected parapneumonic effusions and empyemas
  • Intra-abdominal sepsis
  • Neutropenic sepsis

5 loading doses of 12mg/kg

12mg/kg

20-30mg/L

  • Skin and soft tissue including cellulitis, breast abscesses and mastitis
  • Pneumonia (community, hospital and ventilator acquired and aspiration)
  • Exacerbations of cystic fibrosis
  • Parotitis Sinusitis
  • Otitis externa, media and and mastoiditis
  • Tonsillar pharyngitis and epiglottitis

3 loading doses of 12mg/kg

12mg/kg

20-30mg/L

For dosing in renal impairment and information on dose adjustments please see tables in the main guideline

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