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Pharmacokinetics of a single dose of teicoplanin in burn patients
J A Steer1, R P Papini, A P Wilson
1Department of Microbiology, University College London Hospitals, UK.
Insights
Severe burn patients require higher antibiotic doses. A single 12 mg/kg teicoplanin dose achieved therapeutic levels for 24 hours in adults and children, though monitoring is advised for children.
Area of Science:
- Pharmacology
- Infectious Diseases
- Burn Care
Background:
- Severe burn patients are prone to Gram-positive infections, including methicillin-resistant Staphylococcus aureus.
- These patients often necessitate higher antibiotic dosages due to altered pharmacokinetics.
- Teicoplanin is an antibiotic used for Gram-positive infections.
Purpose of the Study:
- To evaluate the pharmacokinetics of a single intravenous dose of teicoplanin in adult and pediatric severe burn patients.
- To determine if a 12 mg/kg teicoplanin dose achieves therapeutic serum concentrations in this population.
- To compare teicoplanin pharmacokinetics between adult and pediatric burn patients.
Main Methods:
- A single intravenous dose of teicoplanin (12 mg/kg) was administered to 15 adults and 5 children with severe burns.
- Serum teicoplanin concentrations were measured at 12 and 24 hours post-dose.
- Pharmacokinetic parameters, including terminal half-life, were analyzed using compartmental modeling.
- Teicoplanin concentrations in burn wound fluid were also assessed.
Main Results:
- Median serum teicoplanin concentrations at 12 hours were 12.8 mg/L in adults and 7.6 mg/L in children (P < 0.01).
- At 24 hours, median concentrations were 8.3 mg/L in adults and 5.2 mg/L in children.
- The median terminal half-life was significantly longer in adults (114 h) compared to children (38 h).
- Teicoplanin concentration in burn wound fluid was approximately 60% of serum concentration.
Conclusions:
- A single 12 mg/kg intravenous teicoplanin dose is generally sufficient for 24-hour therapeutic coverage in severe burn patients.
- Pharmacokinetic profiles differ between adult and pediatric burn patients, with children exhibiting shorter half-lives.
- Monitoring of serum teicoplanin levels may be beneficial, particularly in pediatric patients or those with high total clearance.
Abstract:
Patients with severe burns are susceptible to infection with Gram-positive organisms including methicillin-resistant Staphylococcus aureus, and often require higher antibiotic dosages compared with other patients. This study examined the pharmacokinetics of a single iv dose of teicoplanin (12 mg/kg) in 15 adults and five children with severe burns. Adults were aged 21-82 years with a median total body surface area (TBSA) burn of 30% (range 15-60%). Children were aged 10 months-l0 years with median TBSA burn of 15% (10-30%). At 12 h, the median serum teicoplanin concentration was 12.8 mg/L (9.027.1 mg/L) in adults and 7.6 mg/L (6.6-l0.8 mg/L) in children, (P < 0.01); at 24 h, the corresponding values were 8.3 mg/L (4.6-l2.9 mg/L) and 5.2 mg/L (4.2-6.0 mg/L). Using a three-compartment model, the median terminal half life in adults was 114 h (47-278 h). Children fitted a two-compartment model with a terminal half-life of 38 h (2l-41 h). The median concentration of teicoplanin in fluid from the burn wound was 60% of the serum antibiotic concentration. A single iv dose of 12 mg/kg of teicoplanin was sufficient to produce therapeutic serum concentrations in burn patients for 24 h, but monitoring of antibiotic levels in serum may be advisable in those with high total clearance, especially children.