Minimally invasive laparoscopic surgery is increasingly conducted in gynecology, as in other fields. Infection, a postoperative complication, occurs rather less often in Japan than Europe or the United States, however, this may be related to differences in the use and dosage of preventive antimicrobial agents. In 80-90% of postoperative gynecological infections in Japan, broad-spectrum antimicrobial agents are effective, even against anaerobes. We believe, however, that infection should be monitored more carefully at individual hospitals, particularly in cases of methicillin-resistant Staphylococcus aureus (MRSA), and see a need for more clinical research on laparoscopic surgery, including randomized control studies.

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We analyzed the clinical efficacy of high dose teicoplanin (TEIC)(1, 600 mg/24 h for the first day and 800 mg/24 h thereafter) and plasma trough concentration of TEIC in MRSA infections in Emergency and Critical Care Medicine, to examine the relationship between a change in the trough concentration after administration of this drug and efficacy and safety.
Results are as follows:
1. The clinical efficacy of TEIC against 10 cases of pneumonia, 2 of septicemia with wound infection due toMRSA was 100%.
2. The bacteriological effectiveness of TEIC consisted of 9 eradicated, 1 decreased, 2 replaced, and O unchanged. Among 8 patients treated with TEIC alone, it consisted of 7 eradicated, O decreased, 1 replaced, and O unchanged. Among 4 patients concomitantly treated with other drugs, it consisted of 2 eradicated, 1 decreased, 1 replaced, and O unchanged. Four of 12 patients showed multibacterial infection with Pseudomonas aeruginosa.
3. No case administered TEIC was found to have any side effects or abnormal laboratory findings. 4. The trough blood TEIC level slightly decreased to 17.5 ±6.7 μg/mL on day 2 and 16.3 ±6.3μg/mL on day 4, showing a steady state, and accumulation of TEIC was as mild as 20.5 ±6.9μg/mL on day 8. There
5. High-dose treatment with TEIC showed highly sharp efficacy and high safety, which was considered to be a very useful method for treatment of severe MRSA infections. was no variation of blood concentrations in the respective patients, moreover.

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We analyzed teicoplanin (TEIC) pharmacokinetics in infants and children using the nonlinear mixed effects model (NONMEM) to estimate population pharmacokinetics parameters. Subjects were 63 children (28 days to 16 years old) prescribed TEIC at Kitasato University Hospital and undergoing therapeutic drug monitoring. Population pharmacokinetics parameters were calculated using 1-compartment model of clearance (CL_TEIC) and volume of distribution (Vd_TEIC). An exponential error model was used to determine interindividual variability and a relative error model for residual variability. Patient age, gender, weight, serum creatinine, and serum albumin were covariates. The observed TEIC serum concentration was 101 points ranging from 4.4-39.1ug/mL. TEIC population pharmacokinetics parameters finally estimated were: CL_TEIC=0.00836×(wt/Scr) ⁰⁷⁸⁶ (L/h) and Vd_TEIC=0.8× wt (L). Interindividual variability was CL_TEIC=26.7 (%) and Vd_TEIC=32.7 (%), and residual variability was 2.8, μg/mL. CL_TEIC changes due to aging correlated well with that of kidney gravity. Model validity was sufficient. Our reports suggest that the population parameters are useful in evaluating TEIC pharmacokinetics in children undergoing long-term hospitalization.

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[in Japanese]

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