Teicoplanin 24-h loading dose regimen using a decision tree model to target serum trough concentration of 15–30 μg/mL: A retrospective study

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IntroductionTeicoplanin (TEIC) is typically administered as a loading dose over 36–48 h. Achieving an effective concentration quickly is expected to treat severe infections, such as sepsis and methicillin-resistant Staphylococcus aureus infections. We aimed to identify the TEIC loading dose to be completed within 24 h, targeting the concentration of 15–30 μg/mL and factors affecting the loading dose by utilizing the decision tree (DT) model. MethodsPatients treated with TEIC between January 2017 and December 2022 who met the 24-h loading dose regimen were enrolled. A LD22.5 (corrected TEIC loading dose targeting concentration of 22.5 μg/mL) was determined, factors affecting the concentration were extracted, and a DT model was constructed. The validity of the DT was assessed using the coefficient of determination (R2) in the DT and population pharmacokinetics (PopPK) models for LD22.5. ResultA total of 149 patients were divided into training (n = 104, 70 %) and test groups (n = 45, 30 %). We indicated an average of 14.5 mg/kg for LD22.5 and extracted four factors (estimated glomerular filtration rate, age, albumin, and C-reactive protein) from the DT model. The R2 values were 0.724, 0.695, 0.681, and 0.653 for the DT models (training and test groups) and two PopPK models, respectively. ConclusionWe established a 24-h loading dose regimen targeting the TEIC concentration of 15–30 μg/mL and identified four factors affecting the loading dose by using DT. By following the indicated DT algorithm flowchat, optimal decisions regarding the loading dose could be made for TEIC therapy.