Age- and gender-related differences in teicoplanin levels in paediatric patients

• Published in: Journal of antimicrobial chemotherapy Vol. 68; no. 10; pp. 2318 - 2323
• Main Authors: Strenger, Volker, Hofer, Nora, Rödl, Siegfried, Hönigl, Martin, Raggam, Reinhard, Seidel, Markus G, Dornbusch, Hans Jürgen, Sperl, Daniela, Lackner, Herwig, Schwinger, Wolfgang, Sovinz, Petra, Benesch, Martin, Urlesberger, Berndt, Urban, Christian
• Format: Journal Article
• Language: English
• Published: England Oxford Publishing Limited (England) 01.10.2013
• Subjects: Adolescence; Adolescent; Age differences; Age Factors; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - blood; Anti-Bacterial Agents - pharmacokinetics; Antibiotics; Antimicrobial agents; Child; Child, Preschool; Female; Gender differences; Gram-positive bacteria; Humans; Infant; Infant, Newborn; Male; Patients; Pediatrics; Pharmacology; Retrospective Studies; Sex Factors; Teicoplanin - administration & dosage; Teicoplanin - blood; Teicoplanin - pharmacokinetics; pharmacokinetics; glycopeptides; therapeutic drug monitoring
• ISSN: 0305-7453; 1460-2091
• DOI: 10.1093/jac/dkt176

Teicoplanin is a glycopeptide antibiotic active against Gram-positive bacteria, including methicillin-resistant staphylococci. While teicoplanin trough levels (TTLs) >10 mg/L are commonly considered appropriate, levels >20 mg/L are aimed for in the treatment of severe infections. Due to toxicity, it is recommended to avoid levels >60 mg/L. In our institution, the initial dosing schedule of teicoplanin (10-15 mg/kg every 12 h for three loading doses and every 24 h thereafter) is adapted according to TTLs analysed by a fluorescence polarization immunoassay on treatment days 2 to 4. Teicoplanin peak levels (TPLs) are analysed in selected cases 30 min after the end of infusion. In a retrospective analysis we evaluated 1357 TTLs and 333 TPLs from 410 treatment episodes from 2005 to 2011. Initial TTLs were <10 mg/L in 14.1% and <20 mg/L in 72.6% of episodes. Toddlers had significantly lower TTLs, with a 2-fold and 2.5-fold increased risk of having levels <10 mg/L (24.6%) and <20 mg/L (82.6%), respectively. For the entire cohort, follow-up TTLs were less likely to be <10 mg/L and more likely to be >20 mg/L when compared with initial TTLs (P < 0.001, each). Adolescent girls had significantly higher initial TPLs (P = 0.001) and significantly higher follow-up TTLs (P = 0.016) than adolescent boys. In parallel, adolescent girls had initial TPLs >60 mg/L significantly more frequently (P = 0.012) and follow-up TTLs <10 mg/L significantly less frequently (P = 0.005). More tailored dosing regimens with higher loading doses, especially for toddlers, should be considered. While further pharmacokinetic data in paediatric patients are pending, therapeutic drug monitoring is mandatory.