Evaluation of factors associated with the achievement of an optimal teicoplanin trough concentration .

Abstract

Because teicoplanin has a long serum half-life, a longer period of time is needed to achieve a steady-state concentration compared with vancomycin. The administration of an initial loading dose has been recommended to reach an effective teicoplanin serum concentration for the treatment of methicillin-resistant <italic>Staphylococcus aureus</italic> (MRSA). However, little is known regarding factors that affect teicoplanin concentration. This study aimed to retrospectively determine which factors are associated with achieving an optimal teicoplanin trough level. We analyzed patients with MRSA infections who were treated with teicoplanin intravenously between January 2010 and July 2014. The effect of loading dose administration was evaluated in patients treated with 1,200mg or 1,600mg of teicoplanin, respectively. Approximately 32% (31/97) of patients achieved the trough concentration target (≥15µg/mL) on the 3^rd or 4^th day. Multivariate analysis showed that loading doses and body surface area (BSA) were associated with trough concentration >15µg/mL on the 3^rd or 4^th day. Moreover, patients treated with the 2-day loading dose (1,600mg group: 800mg/day on 2days) promptly achieved a trough concentration >15µg/mL on the 3^rd or 4^th day compared with those receiving a 1-day loading dose (1,200mg group: 800mg/day on only 1day). The receiver operating characteristic curve showed that the optimal cut-off point of estimated glomerular filtration rate (eGFR) was 56mL/min with 1-day loading dose to achieve a trough concentration target >15µg/mL. These results suggested that patients with decreased renal function (eGFR <56mL/min) can safely achieve an optimal trough level with the 1-day loading dose. In patients with normal renal function (eGFR ≥56mL/min), administration of a 2-day loading dose may be needed to rapidly achieve a trough concentration ≥15µg/mL. .