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
28 june 2024
Our eHealth team advised us yesterday of an international vulnerability relating to polyfill.io . This domain has become compromised and is spreading malware through a widespread supply chain attack, estimated to affect over 110,000 websites including major websites such as the BBC. The Polyfill site offered widely used bits of code for older browsers that allowed the use of modern Javascript features. Such code makes the work for web developers easier and allows compatibility with a broader range of browsers.
Websites that have used the Javascript code from Polyfill have been urged to remove such code immediately. The change occurred after a suspected Chinese firm purchased the domain in early 2024.
Tactuum have identified and are now testing a fix to remove all Polyfill code from the RDS site.. They will be deploying the fix on Monday 1 July along with other planned fixes and amendments. I will notify you of the timing of the deployment as soon as possible.
In the meantime, please ensure that you have up-to-date anti-virus software installed on your machines and personal devices.
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
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
If renal function changes significantly, re-calculate creatinine clearance & dose.
Nephrotoxicity:
Teicoplanin is considered to be LESS nephrotoxic than vancomycin
Other:
Where possible, double check your calculations with the ward pharmacist before prescribing.
1. Calculate the patient's creatinine clearance
2. Decide on using Ideal or Actual 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:
Lamont et al. Journal of Antimicrobial Chemotherapy 2009; 64 : 181-187
Summary of Product Characteristics, Targocid 400mg