TEICOPLANIN ANTIMICROBIAL PRESCRIBING GUIDANCE for Adult patients

• Drug information
• Administration
• Indications and dosing
• Renal impairment dosing
• Therapeutic drug monitoring (TDM)
• Further monitoring
• Discharge information
• Appendix 1 - Indications and dosing for critical care patients

Please refer to the BNF or the Summary of Product Characteristics (SPC) for information on:

• Pharmacokinetics
• Interactions
• Side effects
• Allergy information
• Use in Breastfeeding and pregnancy

DRUG INFORMATION

Class of antimicrobial: Glycopeptide

Antimicrobial spectrum: bactericidal activity against aerobic and anaerobic Gram-positive bacteria including multi-resistant staphylococci. However, there are reports of Staphylococcus aureus with reduced susceptibility to glycopeptides and increasing reports of glycopeptide-resistant enterococci.

Elimination half-life: varies from 100 to 170 hours.

Allergy advice: Contraindication with hypersensitivity to teicoplanin or to any excipients.

Caution should be taken if there has been previous hypersensitivity reported with vancomycin due to the risk of cross-sensitivity between the two agents. However, if “red-man syndrome” has previously been reported with vancomycin, teicoplanin can still be used with caution. If such a reaction occurs, teicoplanin should be stopped immediately and appropriate emergency measures taken.

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ADMINISTRATION

Teicoplanin can be administered intramuscularly and intravenously for a systemic infection (as a bolus for doses <800mg or as an infusion for doses >800mg.)

In rare cases (even at the first dose), red man syndrome has been observed.  Stopping or slowing the infusion may result in cessation of these reactions. Infusion related reactions can be limited if the daily dose is administered as an infusion rather than a bolus.

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INDICATIONS AND DOSING - For dosing in critical care patients see Appendix 1.

The dose is based on actual body weight. Maximum of 2g per single dose.

The dose should be rounded up or down to the nearest 100mg to allow straightforward administration.

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RENAL IMPAIRMENT DOSING

Teicoplanin requires dose reduction in renal impairment. Creatinine clearance (CrCl) using the Cockcroft and Gault calculation should be calculated and eGFR should not be used: https://www.mdcalc.com/creatinine-clearance-cockcroft-gault-equation .

• Use Ideal body weight (IBW) to calculate CrCl if a patient is overweight
• If actual body weight is more than 25% greater than their IBW use adjusted body weight to calculate CrCl.

Patients receiving dialysis at Leeds are not suitable for 72 hour dosing due to the increased clearance of teicoplanin in HDF / Hi-Flux dialysis therefore resulting in subtherapeutic drug levels when dialysis and teicoplanin dosing times do not coincide.

To avoid this, it is advised that the maintenance dose of teicoplanin is reduced as documented in the table above (rounded to the nearest 50mg). On dialysis days the dose should be administered post dialysis.

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THERAPEUTIC DRUG MONITORING (TDM)

• Levels only need to be monitored in patients who are being treated for more than seven days.
• Trough levels should be taken just before the dose is administered.
• Take the initial level before the dose on the fifth day.
• If the dose has been reduced to alternate days, or every 72 hours, take the level before the first dose of this change.
• Levels that are in range should be monitored weekly.
• When dose adjustments have been made due to plasma concentration levels being out of range, take the level on the fifth day after this change.

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FURTHER MONITORING

Severe bullous reactions: if symptoms or signs of Stevens-Johnson syndrome (SJS) or Toxic Epidermal Necrolysis (TEN) (e.g. progressive skin rash often with blisters or mucosal lesions) are present teicoplanin treatment should be discontinued immediately.

Nephrotoxicity and otoxoxicity: deafness and tinnitus has been reported in patients treated with teicoplanin. Patients should be carefully evaluated and monitored, especially in cases of prolonged treatment and renal insufficiency. If receiving other medicines with known neurotoxic/ototoxic potential, patients should be carefully monitored with regular haematology, liver and kidney function test; the benefit of teicoplanin evaluated if hearing deteriorates.

Thrombocytopenia: periodic haematological examinations are recommended during treatment, including complete full blood count.

Any suspected adverse reactions should be reported via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard.

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DISCHARGE INFORMATION

The Outpatient Parenteral Antimicrobial Therapy (OPAT) service can support with discharging patients requiring teicoplanin. Please refer to the OPAT/CIVAS team. The OPAT drug monographs includes all of the information required for administration, reconstitution and supply at discharge.

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