Antimicrobial prescribing: NHS Lothian
Nephrotoxicity:
- Dose-dependent
- Ensure good hydration
- Avoid co-prescription of nephrotoxins (e.g. furosemide)
Teicoplanin is considered to be LESS nephrotoxic than vancomycin
Other:
- Drug fever
- Skin reactions
- Ototoxicity
- Eosinophilia
- Leucopenia
Teicoplanin for OPAT
This guidance is for OPAT and ward staff initiating thrice-weekly dosing of teicoplanin.
It is only approved for ward use in patients who have been accepted by the OPAT service. Other regimens/target trough levels are used in other services (e.g. oncology, paediatrics, Hospital@Home etc).
Exclusions and contraindications
- Hypersensitivity to teicoplanin or its excipients.
- Known true anaphylactic allergy to glycopeptides (vancomycin, dalbavancin etc)
Caution: Non-anaphylactic allergy to Vancomycin
A prior history of "red man syndrome" with vancomycin is NOT a contraindication to the use of teicoplanin
Required monitoring
- Take U+E and Teicoplanin trough level:
- With first maintenance dose.
- And then ONCE a WEEK thereafter
- Target trough level is 20-30 mg/L
If renal function changes significantly, re-calculate creatinine clearance & dose.
Where possible, double check your calculations with the ward pharmacist before prescribing.
1. Calculate the patient's creatinine clearance
- Calculate using patient's age, height, weight & serum creatinine.
- Calculator available here (NB: Intranet only)
- Other online calculators can be used as long as they use the Cockcroft-Gault formula
- As a last resort calculate manually.
2. Decide on using Ideal or Actual body weight
- Compare the patient's actual weight against the ideal body weight for the patient's height on this table here.
- For the next step use whichever weight is lower of the actual or ideal body weight.
3. Prescribe Teicoplanin loading doses (Daily for first 3 days)
Using the table below, based on the calculated creatinine clearance, to choose the mg/kg dose that applies to your patient.
Prescribe the recommended dose daily for 3 days.
|
|
Creatinine Clearance (ml/min) |
Ideal/Actual body weight |
||
|
40-59 kg |
60-79 kg |
>80 kg |
||
|
Teicoplanin loading dose |
<60 |
1000 mg |
1200 mg |
1400 mg |
|
Teicoplanin loading dose |
≥60 |
1200 mg |
1400 mg |
1600 mg |
Choose which day you want maintenance doses to start (Monday is preferred):
|
Loading doses to be given on |
First trough level & maintenance doses start day |
|
Wed/Thurs/Fri |
Monday |
|
Fri/Sat/Sun |
Wednesday |
|
Sun/Mon/Tues |
Friday |
4. Prescribe Teicoplanin maintenance dosePrescribe maintenance dose based on Creatinine Clearance from table below on Monday, Wednesday & Friday:
| Creatinine Clearance (ml/min) | Teicoplanin maintenance dose |
| <25 | 400 mg |
| 25-40 | 600 mg |
| 41-54 | 800 mg |
| 55-74 | 1000 mg |
| 75-89 | 1200 mg |
| 90-104 |
1400 mg |
| 105-120 | 1600 mg |
| >120 | 1800 mg |
5. Document on TRAK the calculation
TRAK short code \teicopat
-----------------------
TEICOPLANIN DOSING CALCULATIONS
Height (cm):
Weight (kg):
Creatinine (mmol/L):
IDEAL or ACTUAL (specify) body weight used in calculations (kg):
Loading doses (give once daily for 3 days):
Loading days:
Maintenance dosage:
Day of first maintenance dose:
Teicoplanin trough level is 20-30 mg/L
|
Teicoplanin Trough |
Advice |
| <15 | Very low; discuss with pharmacist |
| 15 - 20 | Low; increase maintenance dose by 200mg |
| 20 - 30 | In range |
| 30 - 35 | High; decrease maintenance dose by 200mg |
| >35 | Very high; discuss with pharmacist |
Additionally, consult with pharmacist if:
- Creatinine changes by +/- 10%
- Patients on 800mg or less with a trough level <20
Lamont et al. Journal of Antimicrobial Chemotherapy 2009; 64 : 181-187
Summary of Product Characteristics, Targocid 400mg