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Teicoplanin pharmacokinetics in pediatric patients
1Hospital Materno-Infantil Vall d'Hebron, Universidad Autónoma de Barcelona, Spain.
Insights
Higher teicoplanin maintenance dosages (15-20 mg/kg/day) are needed for pediatric bone marrow transplant patients with febrile neutropenia to achieve effective serum concentrations. Lower doses (10 mg/kg/day) were insufficient.
Area of Science:
- Pediatric Hematology Oncology
- Infectious Diseases
- Pharmacology
Background:
- High incidence of infections caused by methicillin-resistant Gram-positive bacteria in febrile neutropenic children.
- Teicoplanin is a viable alternative to vancomycin, but pediatric pharmacokinetic data and optimal dosing are lacking.
- Pediatric bone marrow transplant recipients are particularly vulnerable to these infections.
Purpose of the Study:
- To evaluate the pharmacokinetics of teicoplanin in pediatric patients undergoing bone marrow transplantation.
- To determine optimal teicoplanin dosage regimens for Gram-positive infections in this vulnerable population.
- To assess teicoplanin's efficacy in combination with other antibiotics.
Main Methods:
- A study involving 21 pediatric patients divided into two groups based on teicoplanin maintenance dosage (10 mg/kg/day vs. 20 mg/kg/day).
- Loading doses of 10 mg/kg were administered every 12 hours for three doses.
- Plasma teicoplanin concentrations were monitored, with a target trough value of >10 mg/l.
Main Results:
- Patients receiving 10 mg/kg/day maintenance dosage did not consistently achieve target trough values (>10 mg/l), with five requiring treatment modification.
- All patients receiving 20 mg/kg/day maintenance dosage achieved the desired trough values.
- Teicoplanin demonstrated excellent tolerance in all study participants.
Conclusions:
- Maintenance dosages of 15-20 mg/kg/day of teicoplanin are recommended for febrile neutropenic pediatric bone marrow transplant patients.
- Lower maintenance dosages of 10 mg/kg/day are insufficient to guarantee therapeutic teicoplanin serum trough concentrations.
- Optimized teicoplanin dosing is crucial for effectively managing Gram-positive infections in immunocompromised children.
Background:
The incidence of methicillin-resistant Gram-positive bacteria infections in febrile neutropenic children is high. Teicoplanin is an alternative treatment to vancomycin in these patients but few pharmacokinetic studies of teicoplanin in children have been conducted and optimal dosages have not been well-established.
Objectives:
To assess the pharmacokinetics of teicoplanin in combination with another antibiotic in Gram-positive infections in pediatric patients undergoing bone marrow transplantation and to determine the most appropriate dosage regimen for this type of patient.
Methods:
We studied 21 patients divided into 2 groups. In Group A (n = 9) the dosage regimen consisted of 3 loading doses of 10 mg/kg at 12-h intervals, followed by a maintenance dosage of 10 mg/kg/day. Group B (n = 12) received the same loading dose and a maintenance dosage of 20 mg/kg/day. Plasma teicoplanin concentrations were monitored in all patients from the second day after the start of treatment and periodically thereafter. Serum concentrations above 10 mg/l were established as desirable trough values.
Results:
In Group A trough values > 10 mg/l were not reached in five patients and treatment was modified owing to persistent fever. In Group B all patients attained trough values > 10 mg/l. Tolerance to treatment was excellent.
Conclusion:
In febrile neutropenic pediatric patients undergoing bone marrow transplantation, maintenance dosages of teicoplanin between 15 and 20 mg/kg/day assure serum concentrations above 10 mg/l. Dosages of 10 mg/kg/day do not assure serum through values above 10 mg/l.