Teicoplanin in patients with chronic renal failure on dialysis: microbiological and pharmacokinetic aspects

A significant increase in the incidence of methicillin resistance was found in coagulase-negative staphylococci isolated from infected dialysis fluids in 1985 compared with the previous year. Vancomycin and teicoplanin were active against all these isolates, and had similar minimum inhibitory and bactericidal concentrations. The pharmacokinetic behaviour of teicoplanin in 23 dialysis patients was studied. A single, intravenous dose of teicoplanin was given to 11 patients on haemodialysis (HD) and seven patients on chronic ambulatory peritoneal dialysis (CAPD). In five CAPD patients, 40 mg was added to each 2 litre bag of dialysate for a five day period. Twenty such bags were exchanged. The study showed that a) teicoplanin was not removed from the body by HD or CAPD, b) less than 3% of the administered dose appeared in the urine, c) serum levels reached a plateau of 3-4 micrograms/ml after 40 hours and were maintained for at least five days, regardless of the route of administration or form of dialysis. These findings have obvious implications regarding appropriate treatment regimens in dialysis patients.