Evaluation of teicoplanin concentrations for loading-dose optimization across BMI categories

This study aimed to evaluate the relationship between teicoplanin trough concentrations and loading doses and to identify the appropriate body-weight descriptor for loading doses across BMI categories.

This retrospective study included adult patients whose teicoplanin trough concentrations had been measured. Cumulative loading doses and trough concentrations were compared among the underweight (BMI < 18.5 kg/m2), normal-weight (BMI 18.5-24.9 kg/m2) and overweight/obese (BMI ≥ 25.0 kg/m2) groups. Trough concentrations at the guideline-recommended loading dose scaled to different body-weight descriptors were simulated using individual pharmacokinetic parameters to evaluate the target attainment rate (TAR) within the target range 15-30 mg/L.

In total, 206 patients were analysed, comprising 35 underweight, 131 normal-weight and 40 overweight/obese patients. The overweight/obese group received significantly lower loading doses than the other two groups. In contrast, Day 4 trough concentrations did not differ significantly between the underweight, normal-weight and overweight/obese groups, with median concentrations of 23.2, 23.7 and 24.1 mg/L, respectively. Simulation analysis showed that total body weight (TBW)-based dosing achieved a high TAR in the underweight and normal-weight groups (84% and 85%, respectively) and a lower TAR (71%) with a higher median of 27.2 mg/L in the overweight/obese group. The body-weight descriptor yielding a higher TAR than TBW-based dosing in the overweight/obese group varied by target range, with overlapping 95% CIs indicating no clear superiority.

Simulation analysis suggests that TBW-based loading doses may lead to teicoplanin overexposure in overweight/obese patients. Further studies are warranted to identify the appropriate body-weight descriptor for loading doses in this population.