Teicoplanin oral and parenteral
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Oral and parenteral formulations containing teicoplanin.
Drugs List
Therapeutic Indications
Uses
Bacterial endocarditis
Bone and joint infection
Clostridium difficile associated diarrhoea
Infections due to Gram-positive organisms incl. penicillin-resistant staph.
Peritonitis associated with dialysis
Indicated for the treatment of serious Gram-positive infections including:
Skin and soft tissue infections
Urinary tract infections
Hospital or community acquired pneumonia
Joint and bone infections
Endocarditis
Peritonitis related to continuous ambulatory peritoneal dialysis
Clostridium difficile associated diarrhoea
Bacteraemia that occurs in association with any of the indications listed above
Unlicensed Uses
Prophylaxis against infection during surgical procedures
Surgical prophylaxis where there is a risk of Gram-positive bacterial infection
Dosage
Teicoplanin must not be administered for more than four months. For endocarditis a minimum of twenty-one days is considered appropriate.
Adults
Monitor patients for adverse reactions when doses of 12mg/kg twice a day are administered. Patients on this regime should have blood creatinine values monitored in addition to the recommended periodic haematological examination.
Targeted trough concentrations listed below are measured by Fluorescence Polarization Immunoassay (FPIA) method.
Complicated skin and soft tissue infections, complicated urinary tract infections and lower respiratory tract infections
Loading dose: 6mg/kg intravenously or by intramuscular injection every 12 hours for 3 doses.
Maintenance dose: 6mg/kg intravenously or by intramuscular injection once a day.
Targeted trough concentrations
At day 3 to 5: Greater than 15mg/L.
During maintenance: Greater than 15mg/L once a week.
Bone and joint infections
Loading dose: 12mg/kg intravenously every 12 hours for 3 to 5 doses.
Maintenance dose: 12mg/kg intravenously or by intramuscular injection once a day.
Targeted trough concentrations
At day 3 to 5: Greater than 20mg/L.
During maintenance: Greater than 20mg/L.
Endocarditis
Loading dose: 12mg/kg intravenously every 12 hours for 3 to 5 doses.
Maintenance dose: 12mg/kg intravenously or by intramuscular injection once a day.
Targeted trough concentrations
At day 3 to 5: 30-40mg/L.
During maintenance: Greater than 30mg/L.
Treatment of Clostridium difficile associated diarrhoea
100mg to 200mg orally twice a day for 7 to 14 days.
Surgical prophylaxis (unlicensed)
400mg by intravenous injection up to 30 minutes before procedure.
For open fractures, 800mg by intravenous infusion up to 30 minutes before skeletal stabilisation and definitive soft tissue closure.
Peritonitis related to continuous ambulatory peritoneal dialysis
Loading dose: 6mg/kg intravenously as a single dose.
Dose: 20mg/L is administered in the bag of the dialysis solution in the first week, 20mg/L per alternate bag in the second week and 20mg/L in the overnight dwell bag only during the third week.
Children
Children aged over 12 years
(See Dosage; Adult).
Children aged 2 months to 12 years
Loading dose: 10mg/kg intravenously every 12 hours for the first 3 doses.
Maintenance dose: 6mg/kg to 10mg/kg intravenously as a single dose each day.
Children aged 1 to 2 months
Loading dose: 16mg/kg as a single dose on first day by intravenous infusion over 30 minutes.
Maintenance dose: 8mg/kg once a day by intravenous infusion over 30 minutes.
Neonates
Loading dose: 16mg/kg as a single dose on first day by intravenous infusion over 30 minutes.
Maintenance dose: 8mg/kg once a day by intravenous infusion over 30 minutes.
Patients with Renal Impairment
Dosing should be adjusted to maintain a serum trough concentration of at least 10mg/L when measured by High Performance Liquid Chromatography (HPLC) or at least 15mg/L when measured by FPIA method.
Teicoplanin is not removed by dialysis.
Creatinine clearance between 30 and 80ml/minute
From the fourth day, halve the maintenance dose either by administering the dose every two days, or by administering half of this dose once daily.
Creatinine clearance less than 30ml/minute or haemodialysed patients
From the fourth day, the dose should be one third of the normal dose, either by administering the initial unit dose every third day or by administering one third of this dose once each day.
Administration
The reconstituted injection may be administered intravenously, intramuscularly or orally.
For the treatment of Clostridium difficile associated diarrhoea teicoplanin is given orally.
If given intravenously, teicoplanin may be administered as an intravenous bolus injection over 3 to 5 minutes or as an intravenous infusion over 30 minutes.
Intravenous route is preferable in children. Only intravenous infusion must be used in neonates.
Therapeutic Drug Monitoring
Determination of teicoplanin serum concentrations may optimise therapy. The manufacturer suggests, for most gram-positive infections, trough levels of at least 10 mg/L when measured by High Performance Liquid Chromatography (HPLC), or at least 15 mg/L when measured by FPIA method. For endocarditis and other severe infections, trough levels of 15 to 30 mg/L when measured by HPLC, or 30 to 40 mg/L when measured by FPIA method. During maintenance treatment teicoplanin trough serum concentrations monitoring may be performed at least once a week.
Contraindications
None known
Precautions and Warnings
Breastfeeding
Haemodialysis
Pregnancy
Renal impairment - creatinine clearance below 80ml/min
Potentially ototoxic and nephrotoxic-use with care in renal insufficiency
Reduce dose in patients with creatinine clearance below 80ml/min
Advise ability to drive/operate machinery may be affected by side effects
Consult national/regional policy on the use of anti-infectives
Not all routes are licensed for all indications
Avoid rapid infusion rates
Suspend treatment or reduce rate until infusion reactions resolve
Monitor auditory function in at risk patients before and during treatment
Monitor blood values regularly
Monitor hepatic function
Monitor peak and trough serum levels
Monitor periodically for overgrowth of non-susceptible organisms
Monitor renal function
Discontinue treatment if Stevens-Johnson Syndrome suspected
Prolonged use may result in superinfection with non-susceptible organisms
Discontinue if hypersensitivity reactions occur
Discontinue if severe skin reaction occurs
Discontinue if tinnitus occurs
Avoid long term use
Pregnancy and Lactation
Pregnancy
Use teicoplanin with caution during pregnancy.
There is limited evidence of teicoplanin use in pregnancy. The manufacturer advises that teicoplanin should only be used during pregnancy when clearly necessary.
Animal studies have shown reproductive toxicity at high doses. In rats, there was an increase in stillbirth and neonatal mortality.
Lactation
Use teicoplanin with caution in breastfeeding.
The manufacturer suggests weighing up the benefit of breastfeeding and the benefit of teicoplanin therapy for the mother when deciding whether continue with teicoplanin therapy whilst breastfeeding.
It is not known if teicoplanin is excreted in breast milk.
Side Effects
"Red man" syndrome (flushing of upper body)
Abscess formation (injection site)
Agranulocytosis
Alterations in hepatic enzymes
Anaphylactic reaction
Anaphylactic shock
Angioedema
Bronchospasm
Deafness
Diarrhoea
Dizziness
Dyspnoea
Eosinophilia
Erythema at injection site
Erythema multiforme
Exfoliative dermatitis
Headache
Hearing loss
Hypotension
Increase in alkaline phosphatase
Increase in serum ALT/AST
Leucopenia
Local pain (injection site)
Nausea
Neutropenia
Pain
Phlebitis
Pruritus
Pyrexia
Rash
Renal failure
Rigors
Seizures
Serum creatinine increased
Stevens-Johnson syndrome
Superinfections
Tachycardia
Thrombocytopenia
Thrombophlebitis (localised)
Tinnitus
Toxic epidermal necrolysis
Urticaria
Vestibular disorders
Vomiting
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: October 2019
Reference Sources
Summary of Product Characteristics: Targocid 200 mg powder for solution for injection/infusion or oral solution. Sanofi-Aventis. Revised December 2017.
Summary of Product Characteristics: Targocid 400 mg powder for solution for injection/infusion or oral solution. Sanofi-Aventis. Revised December 2017.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 13 August 2019
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
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