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


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.


Inflammatory response Pharmacokinetics Severe sepsis Systemic inflammatory response syndrome Teicoplanin 




Conflicts of interest

The authors declare that there are no conflicts of interest.


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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

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