Advertisement

International Journal of Clinical Pharmacy

, Volume 38, Issue 4, pp 908–914 | Cite as

Change of teicoplanin loading dose requirement for incremental increases of systemic inflammatory response syndrome score in the setting of sepsis

  • Takafumi NakanoEmail author
  • Yoshihiko Nakamura
  • Tohru Takata
  • Keiichi Irie
  • Kazunori Sano
  • Osamu Imakyure
  • Kenichi Mishima
  • Koujiro Futagami
Research Article
First Online:

Abstract

Background Target trough concentrations are recommended for teicoplanin (TEIC) to minimize its adverse effects and to maximize efficacy in sepsis caused by grampositive cocci, including methicillin-resistant Staphylococcus aureus infection. However, optimal doses to attain proper trough values in patients with sepsis have not yet been well established for TEIC. Objective This study investigated whether the systemic inflammatory response syndrome (SIRS) score could predict the pharmacokinetics of TEIC in patients with sepsis. Setting This study was conducted at Fukuoka University Hospital in Japan. Methods We retrospectively reviewed the records of patients using TEIC between April 2012 and March 2015. SIRS positive was defined as infection with a SIRS score ≥2. Estimates of pharmacokinetic parameters were calculated using a Bayesian method. Creatinine clearance rates were estimated by the Cockcroft–Gault formula (eCcr). Main outcome measure Change of TEIC loading dose requirement for incremental increases of SIRS score. Results In total, 133 patients were enrolled: 50 non-SIRS patients and 83 patients with SIRS. The TEIC plasma trough concentration was significantly lower in SIRS than non-SIRS patients (15.7 ± 7.1 vs. 20.1 ± 8.6 μg/mL; P < 0.01), although there was no significant difference in the loading dose administered. Moreover, SIRS scores were increasingly predictive of eCcr and TEIC clearance in a stepwise manner. To achieve the target trough concentration (15–30 μg/mL), the optimal doses required in non-SIRS versus SIRS patients were 12–24 versus 18–30 mg/kg/day, respectively, during the first 48 h. Conclusions These findings suggest that the pharmacokinetics of TEIC are altered in SIRS patients, who required higher doses than non-SIRS patients to achieve the target trough concentration. We suggest that the SIRS score can become a new modality to determine the initial TEIC loading dose.

Keywords

Inflammatory response Pharmacokinetics Severe sepsis Systemic inflammatory response syndrome Teicoplanin 
This is a preview of subscription content, log in to check access.

Notes

Funding

None.

Conflicts of interest

The authors declare that there are no conflicts of interest.

References

  1. 1.
    Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM consensus conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101:1644–55.CrossRefPubMedGoogle Scholar
  2. 2.
    Mylona V, Koussoulas V, Tzivras D, Makrygiannis E, Georgopoulou P, Koratzanis G, et al. Changes in adaptive and innate immunity in patients with acute pancreatitis and systemic inflammatory response syndrome. Pancreatology. 2011;11:475–81.CrossRefPubMedGoogle Scholar
  3. 3.
    Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med. 2008;34:17–60.CrossRefPubMedGoogle Scholar
  4. 4.
    Kumar A, Ellis P, Arabi Y, Roberts D, Light B, Parrillo JE, et al. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest. 2009;136:1237–48.CrossRefPubMedGoogle Scholar
  5. 5.
    McKenzie C. Antibiotic dosing in critical illness. J Antimicrob Chemother. 2011;66:ii25–31.CrossRefPubMedGoogle Scholar
  6. 6.
    Brauers J, Kresken M, Menke A, Orland A, Weiher H, Morrissey I. Bactericidal activity of daptomycin, vancomycin, teicoplanin and linezolid against Staphylococcus aureus, Enterococcus faecalis and Enterococcus faecium using human peak free serum drug concentrations. Int J Antimicrob Agents. 2007;29:322–5.CrossRefPubMedGoogle Scholar
  7. 7.
    Lin SH, Lai CC, Tan CK, Liao WH, Hsueh PR. Comparative efficacy of vancomycin and teicoplanin in the treatment of hospitalised elderly patients with persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia. Int J Antimicrob Agents. 2011;37:179–81.CrossRefPubMedGoogle Scholar
  8. 8.
    Svetitsky S, Leibovici L, Paul M. Comparative efficacy and safety of vancomycin versus teicoplanin: systematic review and meta-analysis. Antimicrob Agents Chemother. 2009;53:4069–79.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    The Japanese Association for Infectious Diseases, the Japanese Society of Chemotherapy. The JAID/JSC guide to clinical management of infectious diseases. Tokyo: Sanposha Printing; 2014.Google Scholar
  10. 10.
    Matsumoto K, Kanazawa N, Ikawa K, Fukamizu T, Shigemi A, Yaji K, et al. Determination of teicoplanin trough concentration target and appropriate total dose during the first 3 days: a retrospective study in patients with MRSA infections. J Infect Chemother. 2010;16:193–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Harding I, MacGowan AP, White LO, Darley ES, Reed V. Teicoplanin therapy for Staphylococcus aureus septicaemia: relationship between pre-dose serum concentrations and outcome. J Antimicrob Chemother. 2000;45:835–41.CrossRefPubMedGoogle Scholar
  12. 12.
    Wilson AP. Clinical pharmacokinetics of teicoplanin. Clin Pharmacokinet. 2000;39:167–83.CrossRefPubMedGoogle Scholar
  13. 13.
    Mimoz O, Rolland D, Adoun M, Marchand S, Breilh D, Brumpt I, et al. Steady state trough serum and epithelial lining fluid concentrations of teicoplanin 12 mg/kg per day in patients with ventilator-associated pneumonia. Intensive Care Med. 2006;32:775–9.CrossRefPubMedGoogle Scholar
  14. 14.
    The Japanese Society of Chemotherapy, the Japanese Society of Therapeutic Drug Monitoring. Clinical practice guidelines for TDM of antimicrobial agents. Tokyo: Kyorinsha; 2012.Google Scholar
  15. 15.
    Noguchi S, Ueda Y, Shibuya M, Konomatsu A, Ito A, Shimada Y, et al. Effectiveness of treatment strategy using high-dose teicoplanin (TEIC) in emergency and critical care medicine. Jpn J Pharm Health Care Sci. 2008;34:662–70.CrossRefGoogle Scholar
  16. 16.
    Mitsuda M, Noguchi K, Kosako K, Tsuji N, Nogiwa T, Matsubara F, et al. Clinical efficacy of teicoplanin with high-dose loading regimen for MRSA infection. Jpn J TDM. 2009;26:14–20.Google Scholar
  17. 17.
    Ueda T, Takesue Y, Nakajima K, Ichki K, Wada Y, Tsuchida T, et al. Evaluation of teicoplanin dosing designs to achieve a new target trough concentration. J Infect Chemother. 2012;18:296–302.CrossRefPubMedGoogle Scholar
  18. 18.
    Nakano T, Nakamura Y, Togawa A, Takata T, Ishikura H, Mishima K, et al. Necessity of personalized initial loading dose calculation of teicoplanin by clinical pharmacist-examination of the utility of using systemic inflammatory response syndrome score. Yakugaku Zasshi. 2014;134:1367–73.CrossRefPubMedGoogle Scholar
  19. 19.
    Yamaoka K, Nakagawa T, Tanaka H, Yasuhara M, Okumura K, Hori R, et al. A nonlinear multiple regression program, MULTI2 (BAYES), based on Bayesian algorithm for microcomputers. J Pharmacobiodyn. 1985;8:246–56.CrossRefPubMedGoogle Scholar
  20. 20.
    Nakayama K, Gemma H, Kaibara A, Niwa T. Population pharmacokinetics of teicoplanin in adult patients. Jpn J Chemother. 2006;54:1–6.Google Scholar
  21. 21.
    Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Blot S, Lipman J, Roberts DM, Roberts JA. The influence of acute kidney injury on antimicrobial dosing in critically ill patients: are dose reductions always necessary? Diagn Microbiol Infect Dis. 2014;79:77–84.CrossRefPubMedGoogle Scholar
  23. 23.
    Shimamoto Y, Fukuda T, Tanaka K, Komori K, Sadamitsu D. Systemic inflammatory response syndrome criteria and vancomycin dose requirement in patients with sepsis. Intensive Care Med. 2013;39:1247–52.CrossRefPubMedGoogle Scholar
  24. 24.
    Otto GP, Sossdorf M, Breuel H, Schlattmann P, Bayer O, Claus RA, et al. Renal outcome after vancomycin treatment and renal replacement therapy in patients with severe sepsis and septic shock: a retrospective study. J Crit Care. 2014;29:656–61.CrossRefPubMedGoogle Scholar
  25. 25.
    Minkutė R, Briedis V, Steponavičiūtė R, Vitkauskienė A, Mačiulaitis R. Augmented renal clearance–an evolving risk factor to consider during the treatment with vancomycin. J Clin Pharm Ther. 2013;38:462–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Tröger U, Drust A, Martens-Lobenhoffer J, Tanev I, Braun-Dullaeus RC, Bode-Böger SM. Decreased meropenem levels in intensive care unit patients with augmented renal clearance: benefit of therapeutic drug monitoring. Int J Antimicrob Agents. 2012;40:370–2.CrossRefPubMedGoogle Scholar
  27. 27.
    Udy AA, Varghese JM, Altukroni M, Briscoe S, McWhinney BC, Ungerer JP, et al. Subtherapeutic initial β-lactam concentrations in select critically ill patients: association between augmented renal clearance and low trough drug concentrations. Chest. 2012;142:30–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Irikuchi J, Imai T, Yoshida Y, Orii T. Influence of systemic inflammatory response syndrome on the pharmacokinetics of vancomycin. Yakugaku Zasshi. 2015;135:745–51.CrossRefPubMedGoogle Scholar
  29. 29.
    Pinder M, Bellomo R, Lipman J. Pharmacological principles of antibiotic prescription in the critically ill. Anaesth Intensive Care. 2002;30:134–44.PubMedGoogle Scholar
  30. 30.
    Domart Y, Pierre C, Clair B, Garaud JJ, Regnier B, Gibert C. Pharmacokinetics of teicoplanin in critically ill patients with various degrees of renal impairment. Antimicrob Agents Chemother. 1987;31:1600–4.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Gemmell CG, Edwards DI, Fraise AP, Gould FK, Ridgway GL, Warren RE. Guidelines for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections in the UK. J Antimicrob Chemother. 2006;57:589–608.CrossRefPubMedGoogle Scholar
  32. 32.
    Tobin CM, Lovering AM, Sweeney E, MacGowan AP. Analyses of teicoplanin concentrations from 1994 to 2006 from a UK assay service. J Antimicrob Chemother. 2010;65:2155–7.CrossRefPubMedGoogle Scholar
  33. 33.
    Brink AJ, Richards GA, Cummins RR, Lambson J, Gauteng Understanding Teicoplanin Serum levels (GUTS) Study Group. Recommendations to achieve rapid therapeutic teicoplanin plasma concentrations in adult hospitalized patients treated for sepsis. Int J Antimicrob Agents. 2008;32:455–8.CrossRefPubMedGoogle Scholar
  34. 34.
    Pea F, Viale P, Candoni A, Pavan F, Pageni L, Dasini D, et al. Teicoplanin in patients with acute leukaemia and febrile neutropenia: a special population benefiting from higher dosages. Clin Pharmacokinet. 2004;43:405–15.CrossRefPubMedGoogle Scholar
  35. 35.
    Ueda T, Takesue Y, Nakajima K, Ichki K, Wada Y, Komatsu M, et al. High-dose regimen to achieve novel target trough concentration in teicoplanin. J Infect Chemother. 2014;20:43–7.CrossRefPubMedGoogle Scholar
  36. 36.
    Matsumoto K, Kanazawa N, Watanabe E, Yokoyama Y, Fukamizu T, Shimodozono Y, et al. Development of initial loading procedure for teicoplanin in critically ill patients with severe infections. Biol Pharm Bull. 2013;36:1024–6.CrossRefPubMedGoogle Scholar
  37. 37.
    Nakamura A, Takasu O, Sakai Y, Sakamoto T, Yamashita N, Mori S, et al. Development of a teicoplanin loading regimen that rapidly achieves target serum concentrations in critically ill patients with severe infections. J Infect Chemother. 2015;21:449–55.CrossRefPubMedGoogle Scholar
  38. 38.
    Lamont E, Seaton RA, Macpherson M, Semple L, Bell E, Thomson AH. Development of teicoplanin dosage guidelines for patients treated within an outpatient parenteral antibiotic therapy (OPAT) programme. J Antimicrob Chemother. 2009;64:181–7.CrossRefPubMedGoogle Scholar
  39. 39.
    van der Poll T. Immunotherapy of sepsis. Lancet Infect Dis. 2001;1:165–74.CrossRefPubMedGoogle Scholar
  40. 40.
    Gosling P, Sanghera K, Dickson G. Generalized vascular permeability and pulmonary function in patients following serious trauma. J Trauma. 1994;36:477–81.CrossRefPubMedGoogle Scholar
  41. 41.
    Roberts JA, Lipman J. Pharmacokinetic issues for antibiotics in the critically ill patient. Crit Care Med. 2009;37:840–51.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing 2016

Authors and Affiliations

  • Takafumi Nakano
    • 1
    • 2
    Email author
  • Yoshihiko Nakamura
    • 3
  • Tohru Takata
    • 4
  • Keiichi Irie
    • 2
  • Kazunori Sano
    • 2
  • Osamu Imakyure
    • 1
  • Kenichi Mishima
    • 2
  • Koujiro Futagami
    • 1
  1. 1.Department of PharmacyFukuoka University HospitalFukuokaJapan
  2. 2.Department of Pharmacology, Faculty of Pharmaceutical SciencesFukuoka UniversityFukuokaJapan
  3. 3.Department of Emergency and Critical Care MedicineFukuoka University HospitalFukuokaJapan
  4. 4.Department of Oncology, Hematology, and Infectious DiseasesFukuoka UniversityFukuokaJapan

Personalised recommendations

Cite article

Buy options