Teicoplanin use in critical care settings: necessity of larger loading dose

Abstract

Objectives: To assess the optimal dosage of teicoplanin in critical care settings. Methods: A retrospective analysis of data obtained from fifty patients without renal replacement support who received teicoplanin therapy in the ICU was performed. Results: Serum trough teicoplanin concentration at 48 hours after starting administration rarely exceeded 10 or 15μg·ml⁻¹ (40% and 15%, respectively) by conventional recommended dosage. Predicted serum trough teicoplanin concentration at 24 hours after the first dosage following 600 mg and 12 mg·kg⁻¹ of teicoplanin administration every 12 hours estimated by Bayesian method were 14.5±5.8 and 15.8±5.1μg·ml⁻¹, respectively. Additionally, serum concentration of five patients with impaired renal function was similar to that from patients with normal renal function at 96 hours after the first dosage. Conclusions: In critical care settings, larger initial dosage of teicoplanin was required to obtain optimal serum concentration regardless of patient's renal function.