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Evaluation of Teicoplanin Trough Values After the Recommended Loading Dose in Children With Associated Safety
Takaaki Yamada1, Toshio Kubota, Mahoro Yonezawa
1From the *Department of Pharmacy, Kyushu University Hospital, †Department of Clinical Pharmacy and Pharmaceutical care, Graduate School of Pharmaceutical Sciences, Kyushu University, and ‡Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Insights
The standard teicoplanin loading dose may not achieve therapeutic trough levels in children. Higher target trough levels (≥20 μg/mL) appear safe for treating deep-seated infections in pediatric patients.
Area of Science:
- Pediatric Pharmacology
- Infectious Diseases
- Clinical Pharmacy
Background:
- Teicoplanin is an antibiotic used for serious bacterial infections.
- Achieving adequate teicoplanin trough levels is crucial for treatment efficacy.
- Pediatric dosing requires careful evaluation due to pharmacokinetic differences.
Purpose of the Study:
- To assess if the recommended teicoplanin loading dose achieves target trough levels (15-30 μg/mL) in children aged 2-16 years.
- To investigate the incidence of renal impairment and hepatic dysfunction associated with teicoplanin therapy in this pediatric population.
Main Methods:
- Retrospective study design.
- Data collected from October 2008 to March 2014.
- Analysis of teicoplanin trough levels, demographic data, and clinical outcomes.
Main Results:
- 46.2% of children had teicoplanin trough levels below 15 μg/mL.
- Significant correlations were found between age, serum creatinine, eGFR, and the concentration/cumulative loading dose ratio.
- Incidences of renal impairment (2.3%) and hepatic dysfunction (5.8%) were low and not significantly different across trough level groups.
Conclusions:
- The recommended teicoplanin loading dose may be insufficient for achieving target trough levels in children with normal renal function.
- A target trough level of ≥20 μg/mL for deep-seated infections appears to be safe in pediatric patients.
Background:
This study evaluated whether the recommended teicoplanin loading dose (3 loading doses of 10 mg/kg every 12 hours) achieves a 15-30 μg/mL trough levels in 26 children (2-16 years). In addition, we examined the incidences of renal impairment and hepatic dysfunction in children treated with teicoplanin.
Methods:
This retrospective study was conducted between October 2008 and March 2014.
Results:
The percentage of patients with a trough level <10 and <15 μg/mL were 15.4% (4/26) and 46.2% (12/26), respectively. There were significant correlations between age and concentration/cumulative loading dose (C/D) ratio (P = 0.045), serum creatinine and C/D ratio (P < 0.001) and estimated glomerular filtration rate and C/D ratio (P = 0.005). Serum creatinine was significantly lower when trough levels were <15 μg/mL compared with ≥15 μg/mL. The incidences of renal impairment and hepatic dysfunction were 2.3% and 5.8%, respectively, with no significant difference between <20 and ≥20 μg/mL trough-level groups.
Conclusions:
The recommended loading dose may be insufficient to achieve 15-30 μg/mL in children with normal renal function. In addition, the target trough level ≥20 μg/mL for deep-seated infections seems to be safe in children.
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