Vol.68 No.6 November 2020

Efficacy and safety of the initial dose of teicoplanin adjusted for the body weight

Yoshiki Katada^{1, 2)}, Syunsaku Nakagawa¹⁾, Hitomi Yamashima¹⁾, Mitsuhiro Sugimoto¹⁾, Masanori Kimata¹⁾, Yuko Yoshida¹⁾, Yuya Matsuda¹⁾, Yu Takahashi¹⁾, Kotaro Itohara¹⁾, Noriaki Kitada¹⁾, Satoshi Imai¹⁾, Sachio Fukatsu¹⁾, Masahiro Tsuda¹⁾, Atsushi Yonezawa¹⁾, Takayuki Nakagawa¹⁾, Masaki Yamamoto^{2, 3)}, Yasufumi Matsumura^{2, 3)}, Miki Nagao^{2, 3)} and Kazuo Matsubara¹⁾

¹⁾Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, 54 Kawahara, Shogoin, Sakyo-ku, Kyoto, Japan
²⁾Department of Infection Control and Prevention, Kyoto University Hospital
³⁾Department of Clinical Laboratory Medicine, Kyoto University Hospital

Abstract

Since teicoplanin (TEIC) has a long elimination half-life, it takes a long time for the steady state concentration to be achieved. Therefore, a loading dose is required for a therapeutic concentration (15-30 μg/mL) to be achieved rapidly. However, the optimal TEIC loading dose method needed to achieve therapeutic concentrations is not yet known. In the present study, we retrospectively investigated the relationship between the initial TEIC dosage based on the body weight and the serum concentration of the drug on the third day. Also, we studied the clinical efficacy and safety of TEIC in relation to the initial dose of TEIC used. From January 2016 to December 2016, a total of 109 adult inpatients received TEIC at Kyoto University Hospital, and the serum levels of the drug were measured on the third administration day. The patients were divided into three dose groups: the low-dose group: ≧10, <20 mg/kg/2 days (n=25); moderate-dose group: ≧20, <30 mg/kg/2 days (n=64); high-dose group: 30-50 mg/kg/2 days (n=20). The TEIC concentrations were significantly higher in the high-dose and moderate-dose groups than in the low-dose group (13.6±8.2, 22.7±7.4, and 27.6±5.24 μg/mL, respectively; P<0.01). The proportion of patients who failed to achieve serum TEIC levels of at least 15 μg/mL was 52% in the low-dose group, 20.3% in the moderate-dose group, and 0% in the low-dose group (P<0.001). There were no significant differences in the incidence of nephrotoxicity or hepatotoxicity among the three groups. The time to achieve a blood culture-negative state was significantly shorter in patients with serum TEIC concentrations of ≧15 μg/mL than in those with <15 μg/mL (10±8.6 and 2.5±0.5 days, respectively; P<0.05). Thus, for rapid achievement of the target concentration, we strongly recommend that the initial loading dose should be over 30 mg/kg for 2 days (15-30 μg/mL).

Key word

teicoplanin, therapeutic drug monitoring, initial dose, body weight

Received

March 4, 2020

Accepted

September 7, 2020

Jpn. J. Chemother. 68 (6): 608-618, 2020