Teicoplanin for OPAT

Antimicrobial prescribing: NHS Lothian
NHS Lothian

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.

Teicoplanin toxicity

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

Calculate Teicoplanin 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

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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:

Adjusting the dose based on levels

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

References

Lamont et al.  Journal of Antimicrobial Chemotherapy 2009; 64 : 181-187

Summary of Product Characteristics, Targocid 400mg