Teicoplanin

Not available in the US

Mechanism of Action

• Bactericidal; binds irreversibly to D-ala-D-ala cell wall precorsor, inhibiting cell wall synthesis

General

• Type: Glycopeptide
• Dosage Forms:
• Common Trade Names:

Adult Dosing

Bacterial Meningitis

• 15-20mg/kg IV q8-12h

Bacterial Endocarditis

• 15mg/kg q12h

Febrile Neutropenia

• 15mg/kg q12h

Skin / soft tissue infection

• 15-20mg/kg q8-12h

Pneumonia

• 15-20mg/kg q8-12h

Sepsis / Bacteremia

• 15-20mg/kg q8-12h

CNS Infection

• 15-20mg/kg q8-12h
  • Up to 2g q8h may be required to achieve adequate CSF penetration

Peritonitis (peritoneal dialysis associated)

• 20-25mg/L, added to dialysate fluid

Pediatric Dosing

General

• 15mg/kg q6hr
• Do not exceed 750mg per dose in patients with normal renal function

Neonates

• 10-15mg/kg q8-24h (depending on PMA)

Special Populations

• Pregnancy Rating: C
• Lactation Risk: Probably safe
• Obesity: Dose based on total body weight; may require more frequent dosing

Renal Dosing

• Load: 15-25mg/kg IV regardless of renal function
• Maintenance: 7.5-15mg/kg/day in 1-3 divided doses (q8-24hr intervals) based on CrCl
  • CrCl >50: 7.5-15mg/kg q12hr
  • CrCl 10-50: 7.5-15mg/kg q24hr
  • CrCl <10: 7.5-15mg/kg q48-72hr (or redose based on levels)
• Therapeutic trough level: 10-20 mcg/mL (15-20 mcg/mL for MRSA or severe infections)

Hepatic Dosing

• No dose adjustment necessary

Contraindications

• Allergy to class/drug

Adverse Reactions

Serious

• Red man syndrome (histamine release - slow down infusion rate)
• Neutropenia (reversible), thrombocytopenia
• Nephrotoxicity (esp with aminoglycosides)
• Ototoxicity (esp with other ototoxins)

Common

• Phlebitis
• GI upset (with PO)

Pharmacology

• Half-life: 6-8 hours (normal renal function); 6-10 days (anuria)
• Metabolism: None
• Excretion: Urine

See Also

• Antibiotics
• Vancocin
• Glycopeptides

Special Populations

• Pregnancy Rating:
• Lactation:
• Renal Dosing
  • Adult
  • Pediatric
• Hepatic Dosing
  • Adult
  • Pediatric

Contraindications

• Allergy to class/drug

Pharmacology

• Half-life:
• Metabolism:
• Excretion:
• Mechanism of Action:

Antibiotic Sensitivities

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	S
	Strep. Pneumoniae	S
	Viridans strep	X1
	Strep. anginosus gp	X1
	Enterococcus faecalis	S
	Enterococcus faecium	I
	MSSA	S
	MRSA	S
	CA-MRSA	S
	Staph. Epidermidis	I
	C. jeikeium	S
	L. monocytogenes	S
Gram Negatives	N. gonorrhoeae	R
	N. meningitidis	R
	Moraxella catarrhalis	X1
	H. influenzae	X1
	E. coli	R
	Klebsiella sp	R
	E. coli/Klebsiella ESBL+	R
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	R
	Enterobacter sp, AmpC pos	R
	Serratia sp	X1
	Serratia marcescens	R
	Salmonella sp	R
	Shigella sp	R
	Proteus mirabilis	X1
	Proteus vulgaris	R
	Providencia sp.	X1
	Morganella sp.	X1
	Citrobacter freundii	X1
	Citrobacter diversus	X1
	Citrobacter sp.	X1
	Aeromonas sp	X1
	Acinetobacter sp.	R
	Pseudomonas aeruginosa	R
	Burkholderia cepacia	R
	Stenotrophomonas maltophilia	R
	Yersinia enterocolitica	X1
	Francisella tularensis	X1
	Brucella sp.	R
	Legionella sp.	X1
	Pasteurella multocida	X1
	Haemophilus ducreyi	X1
	Vibrio vulnificus	X1
Misc	Chlamydophila sp	X1
	Mycoplasm pneumoniae	X1
	Rickettsia sp	R
	Mycobacterium avium	X1
Anaerobes	Actinomyces	X1
	Bacteroides fragilis	X1
	Prevotella melaninogenica	X1
	Clostridium difficile	S
	Clostridium (not difficile)	S
	Fusobacterium necrophorum	X1
	Peptostreptococcus sp.	S

Key

• S susceptible/sensitive (usually)
• I intermediate (variably susceptible/resistant)
• R resistant (or not effective clinically)
• S+ synergistic with cell wall antibiotics
• U sensitive for UTI only (non systemic infection)
• X1 no data
• X2 active in vitro, but not used clinically
• X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
• X4 active in vitro, but not clinically effective for strep pneumonia