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Teicoplanin dose

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Teicoplanin Dosing

Teicoplanin is a glycopeptide antibiotic active against gram-positive organisms (including MRSA and enterococci). Key dosing details from authoritative sources:

Standard Adult Dosing

Loading dose: 15–20 mg/kg IV every 12 hours × 3 doses (to rapidly achieve therapeutic levels given the drug's long half-life)
Maintenance dose: 6–12 mg/kg IV/IM once daily
  • For serious infections (endocarditis, osteomyelitis, bacteraemia): higher end of dosing — up to 12 mg/kg once daily, with some protocols using 15–20 mg/kg loading doses
  • Standard infections: 6 mg/kg once daily is often adequate
For serious infections, a loading regimen of 15–20 mg/kg IV q12h × 3 doses is used, then maintenance — Brenner & Rector's The Kidney

Pharmacokinetics (relevant to dosing)

ParameterValue
RouteIV or IM (unlike vancomycin which is IV only)
Protein binding90–95%
Half-life (t½)Up to 100 hours
Dosing frequencyOnce daily (long t½ allows this)
EliminationGlomerular filtration (renal)
An IV dose of 1 g produces plasma concentrations of 15–30 μg/mL at 1 hour post-infusion. — Goodman & Gilman's Pharmacological Basis of Therapeutics

Renal Impairment

  • Dose reduction required when CrCl < 50–60 mL/min — Comprehensive Clinical Nephrology, 7th Ed.
  • In dialysis patients: teicoplanin can be given at 5–7 day intervals due to its very long half-life, making it practical for peritoneal dialysis patients — Brenner & Rector's The Kidney

Therapeutic Drug Monitoring (TDM)

Target trough levels:
  • Routine infections: 10–15 mg/L
  • Serious infections (endocarditis, MRSA, bone/joint): 15–30 mg/L (some guidelines target ≥20 mg/L)

Key Clinical Notes

  • No "red man syndrome" — unlike vancomycin, infusion-related flushing reactions are generally not observed with teicoplanin
  • Active against MRSA, MRSE, and most enterococci; vanA-type resistance confers resistance to teicoplanin (unlike vanB which often preserves susceptibility)
  • Can be given IM (advantage over vancomycin)
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