Vol.70 No.5 September 2022

Rate of achievement of serum teicoplanin trough concentrations of ≥15 μg/mL, and investigation of factors that cause serum teicoplanin trough concentrations to fluctuate after a loading dose regimen in pediatric malignancy patients

Takamichi Arima^{1, 2)}, Tomomi Sano^{1, 2)}, Mika Shindo^{1, 2)}, Mika Shiotsuka²⁾, Osamu Kobayashi²⁾, Tetsuya Furukawa¹⁾ and Satoshi Iwata²⁾

¹⁾Department of Pharmacy, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
²⁾Department of Infection Control and Prevention, National Cancer Center Hospital

Abstract

According to antimicrobial therapeutic drug monitoring (TDM) guidelines, the target serum trough concentration for teicoplanin (TEIC) in adults is ≥15 μg/mL. However, not enough is known about the safety of serum trough concentrations of ≥15 μg/mL and the optimal loading dose regimens for achieving serum trough concentrations of ≥15 μg/mL in pediatric patients. Therefore, the aims of this study were to (i) evaluate the safety of serum TEIC trough concentrations of ≥15 μg/mL, (ii) evaluate the rate of achievement of serum TEIC trough concentrations of ≥15 μg/mL after administration of loading doses, and (iii) investigate factors that cause serum TEIC trough concentrations to fluctuate in pediatric malignancy patients.
This retrospective study was conducted between April 2014 and March 2020 at the National Cancer Center Hospital. A total of 44 pediatric malignancy patients aged between 0 and 15 years for whom data from at least one serum TEIC trough concentrations measurement were available were included in this study. The patients were divided by the average serum TEIC trough concentrations into the <15 μg/mL group and ≥15 μg/mL group.
The incidence of grade 3 or worse abnormal laboratory values in the <15 μg/mL group vs. ≥15 μg/mL group were as follows: serum creatinine (Scr, 0% vs. 0%), serum aspartate aminotransferase (AST, 5.6% vs. 3.8%), serum alanine aminotransferase (ALT, 5.6% vs. 3.8%). The incidence of adverse reactions did not differ between the <15 μg/mL group and ≥15 μg/mL group.
In this study, administered loading doses yielded target serum TEIC trough concentrations of ≥15 μg/mL in only 38.6% of all the patients (n=44). Multivariate logistic regression analysis identified the number of loading doses as a significant factor influencing the likelihood of achievement of the target TEIC trough concentrations (odds ratio=6.93; 95% confidence interval: 1.44-33.2; P<0.05).
Our results suggest that it is safe to set the target serum trough concentrations at ≥15 μg/mL in pediatric malignancy patients. However, the currently recommended loading doses of TEIC in antimicrobial TDM guidelines was inadequate for rapidly achieving the target serum trough concentrations of ≥15 μg/mL.
A greater number of loading doses of TEIC than the currently recommended TEIC loading doses in the antimicrobial TDM guidelines is required for rapidly achieving serum trough concentrations of ≥15 μg/mL in pediatric malignancy patients.

Key word

teicoplanin, child, oncology, TDM

Received

January 27, 2022

Accepted

June 15, 2022

Jpn. J. Chemother. 70 (5): 387-395, 2022