TEICOPLANIN

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Prescribing and Monitoring Intravenous Teicoplanin in Adults

Teicoplanin is a protected antimicrobial and as such should only be initiated following consultation with an infection specialist. Note teicoplanin doses are based on actual bodyweight (ABW) and dosing frequency after loading is based on renal function. Calculate renal function using on-line calculator (use gentamicin/vancomycin/BNF) or Cockcroft Gault equation (using ideal body weight if actual weight > 20% over ideal). DO NOT use eGFR to determine drug dosing in renal impairment.

Cockcroft-Gault equation

 CrCl (mL/min)  =  

[140 - age (years)] x weight (kg)

Serum creatinine (micromol/L)

Multiply figure obtained above by 1.23 for males and 1.04 for females

For glossary of terms see Glossary

Moderate skin and soft tissue infection OR Uncomplicated line infections WITHOUT sepsis or bacteraemia or significant cellulitis

STEP ONE: Loading

IV 6mg/kg (ABW) to max 400mg 
Every 12 hours for 3 doses

STEP TWO: Maintenance Dose

Start maintenance dose 24, 48 or 72 hours after the last loading dose depending on renal function:

Creatinine Clearance (CrCl)

Teicoplanin dose

(ABW to 600mg max)

Above 80ml/min

IV 6mg/kg daily

30-80ml/min

IV 6mg/kg every 48 hours

Less than 30ml/min

IV 6mg/kg every 72 hours

  • Do not use eGFR, creatinine clearance must be calculated using 'Cockcroft Gault' 
  • Round dose to nearest 100mg
  • Administer as IV infusion over 30 mins

STEP THREE: Teicoplanin Levels

Pre-dose Trough: 15-20mg/L

Bone and joint infection, severe skin and soft tissue infection OR Complicated line infections WITH sepsis or bacteraemia or significant cellulitis

STEP ONE: Loading

IV 12mg/kg (ABW) to max 800mg
Every 12 hours for 4 doses

STEP TWO: Maintenance Dose

Start maintenance dose 24, 48 or 72 hours after the last loading dose depending on renal function:

Creatinine Clearance (CrCl)

Teicoplanin dose

(ABW to max 1000mg)

Above 80ml/min

IV 12mg/kg daily

30-80ml/min

IV 12mg/kg every 48 hours

Less than 30ml/min

IV 12mg/kg every 72 hours

  • Do not use eGFR, creatinine clearance must be calculated using 'Cockcroft Gault'
  • Round dose to nearest 100mg
  • Administer as IV infusion over 60 mins

STEP THREE: Teicoplanin Levels

Pre-dose Trough 20 to 30mg/L

Guidance on Monitoring
  • If expected duration of therapy is longer than 10 days, take 1st teicoplanin trough sample at least 72hours after loading doses complete then once weekly thereafter, according to Microbiology advice.
  • Teicoplanin samples are sent to a Bristol laboratory for analysis and can take up to 3-5 days to be reported.
  • Continue with the same regimen until result available. Seek advice from pharmacy if trough level out of recommended range or if significant deterioration OR improvement in renal function.

Note: OPAT Service uses a separate protocol for three times a week dosing – refer to OPAT team.

Adapted with permission from NHS Greater Glasgow and Clyde policy version 3 approved November 2018

Editorial Information

Last reviewed: 30 May 2019

Next review: 30 May 2021

Author(s): Area Antimicrobiology Team

Version: 1

Approved By: TAM subgroup of ADTC

Reviewer Name(s): Area Antimicrobial Pharmacist