Teicoplanin Inpatient Guideline for Adults 16 years or more (397)
Teicoplanin Inpatient Guideline for Adults 16 years or more (397)
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A guideline is intended to assist healthcare professionals in the choice of disease-specific treatments.
Clinical judgement should be exercised on the applicability of any guideline, influenced by individual patient characteristics. Clinicians should be mindful of the potential for harmful polypharmacy and increased susceptibility to adverse drug reactions in patients with multiple morbidities or frailty.
If, after discussion with the patient or carer, there are good reasons for not following a guideline, it is good practice to record these and communicate them to others involved in the care of the patient.
Introduction
Vancomycin is NHS GGC’s glycopeptide of choice. Please see NHS GGC’s empirical Infection Management Guidelines for vancomycin information and dosage instructions.
Teicoplanin should only be prescribed on advice from an infection specialist or according to agreed local infection management guidelines. Teicoplanin has bacteriostatic activity against most Gram positive organisms including Staphylococcus aureus and Staphylococcus epidermidis. Indications may include:
Complicated skin and soft tissue infection requiring intravenous antibiotics
Bone and joint infection
Line/ vascular access device infection
Endocarditis
STEP 1: Loading Dose
IV 12 mg/kg (use actual body weight, max 800mg) every 12 hours for 4 doses
STEP 2: Maintenance Dose
Start the maintenance dose 24, 48 or 72 hours after the last loading dose depending on dosage interval below:
Creatinine Clearance (CrCl)
Teicoplanin dose (use actual body weight)
> 80 ml/min
IV 12 mg/kg (max 1000 mg) every 24 hours
30 – 80 ml/min
IV 6 mg/kg (max 1000 mg) every 24 hours OR IV 12 mg/kg (max 1000 mg) every 48 hours
< 30 ml/min
IV 4 mg/kg (max 1000 mg) every 24 hours OR IV 12 mg/kg (max 1000 mg) every 72 hours
Renal replacement therapy
Discuss with Renal Pharmacy Team
Do not use eGFR. Calculate creatinine clearance using the NHS GGC Creatinine Clearance Calculator on StaffNet or the NHS GGC Adult Therapeutics Handbook app.
Round each dose to the nearest 100 mg.
Administer as an IV infusion over 60 minutes (see Adult IV Drug Monograph for full details).
STEP 3: Teicoplanin Levels and Monitoring Guidance
Take 1st teicoplanin trough sample at least 72 hours after the last loading dose then ONCE WEEKLY thereafter.
Teicoplanin samples are sent to Bristol for analysis therefore may take 3 – 5 working days to be reported on clinical portal (under biochemistry).
- Skin and soft tissue infection or Line/ vascular access device infection 15 – 30 mg/L
- Bone and joint infection 20 – 40 mg/L
- Endocarditis 30 – 40 mg/L
Continue with the same teicoplanin dosing until the result is available unless creatinine is unstable (e.g. a change of > 15 – 20 %). Seek ongoing dosage advice from pharmacy.
Seek advice from pharmacy if the reported trough concentration is out with the recommended target concentration range above.
