Abstract
Teicoplanin (TEIC) is an anti-MRSA antibiotic that is predominantly excreted in urine in an unaltered form; thus, dosage adjustments are necessary in patients with renal insufficiency and those undergoing hemodialysis. Several reports have indicated that the trough concentration of TEIC should be maintained at more than 10μg/mL. The present study attempted to establish a TEIC dose regimen for renal failure patients undergoing hemodialysis so that a trough drug serum level above 10μg/mL is maintained.
Eight patients with renal failure who were receiving hemodialysis were included in this study. The mean age was 67.0 years, and the mean body weight was 54.1kg. Patients received hemodialysis three times a week, and the durations of hemodialysis treatments ranged between 3 and 4 hours. TEIC concentrations were determined using a fluorescence polarization immunoassay.
When the patients received two doses of 400mg of TEIC on the first day and 400mg on the second and third days, the trough levels of TEIC on the third and fourth days were 13.3±1.4μg/mL (n=5) and 11.5±1.1μg/mL (n=3), respectively. In six of the eight patients, the TEIC levels exceeded 10μg/mL. To maintain the trough levels of TEIC above 10μg/mL, approximately two doses of 400mg were needed weekly. Software that simulated the TEIC concentration was effective for determining the appropriate intervals for administration. Overall, 5.7±2.5% of the TEIC was eliminated by hemodialysis treatment using a cellulose triacetate membrane dialyzer.
The recommended dosage regimen in patients undergoing hemodialysis is two doses of 400mg of TEIC on the first day and 400mg on the second and third days, followed by twice weekly doses. This regimen enables the trough serum concentrations of TEIC to be maintained above 10μg/mL.
