Vol.70 No.3 May 2022
Relationship of high-dose loading/target trough concentration with the safety of teicoplanin in patients with eGFR 10-40 mL/min/1.73 m2
1)Department of Pharmacy, Tosei General Hospital, 160 Nishi oiwake, Seto, Aichi, Japan
2)Department of Infection and Prevention, Tosei General Hospital
3)Department of Infectious Disease, Tosei General Hospital
Abstract
The clinical practice guidelines issued by the Japanese Society of Chemotherapy in 2016 for therapeutic drug monitoring of antibiotics indicate that high-dose loading of teicoplanin is necessary to achieve a trough concentration of ≥15 μg/mL. As there are only a few reports of investigation of the high-dose regimen in patients with renal dysfunction, we investigated the initial trough concentration and safety of a high-dose teicoplanin-loading regimen in patients with renal dysfunction. Patients with an estimated glomerular filtration rate of 10-40 mL/min/1.73 m2 who had received treatment with teicoplanin between May 2007 and November 2020 at Tosei General Hospital were retrospectively enrolled and assigned to one of following 2 groups: recommended loading dose group (26.8-33.5 mg/kg/3 days) and high loading dose group (33.5-50.0 mg/kg/3 days), based on the total teicoplanin dosage by body weight on the first 3 days. Achievement of initial trough concentrations of 15 and 20 μg/mL and occurrence/worsening of renal/hepatic dysfunction were compared between the 2 groups. A total of 79 patients were included, with an average age of 76 (±9.6) years, of whom 60 (75.9%) were men, and 18 (22.8%) were in the recommended loading dose group. An initial trough concentration of ≥15 μg/mL was achieved in 11 patients (61.1%) of the recommended loading dose group, but 54 patients (88.5%) of the high loading dose group (P<0.05), whereas that of ≥20 μg/mL was achieved in 2 patients (11.1%) of the recommended loading dose group and 42 patients (68.9%) of the high loading dose group (P<0.05). Hepatic dysfunction occurred in 2 (11.1%) and 5 (8.2%) patients, and renal dysfunction in 3 (16.7%) and 9 (14.8%) patients of the recommended and high loading dose groups, respectively. Taken together, the results indicate that in patients with renal dysfunction, a target trough concentration of ≥15 μg/mL or ≥20 μg/mL is achieved earlier when a higher loading dose than the recommended loading dose is used, without any worsening of the renal/hepatic dysfunction.
Key word
TDM, teicoplanin, loading dose, renal dysfunction
Received
August 11, 2021
Accepted
March 4, 2022
Jpn. J. Chemother. 70 (3): 334-340, 2022
