Abstract
Twenty-five published clinical studies were reviewed in which teicoplanin serum concentrations were determined. A variety of assay methods were used, including bioassay, solid phase enzyme receptor assay, HPLC and immunoassay, and in some studies, more than 1 methodology was used. Fourteen studies gave sufficient data on the method of assay, timing of assays relative to dosage or during therapy, and route of administration of teicoplanin to be included in a detailed pharmacokinetic analysis. Since a wide range of dosing regimens were employed, the studies were grouped in order to facilitate analysis according to the teicoplanin maintenance dose, either 200 mg, 400 mg or 6 mg/kg/day. Six studies used a dose of 200 mg/day and although the mean trough concentrations varied by as much as 3-fold, they did not exceed 10 mg/L in the first 7 days of therapy. Six studies used a 400 mg/day maintenance dose and the mean trough concentrations varied from 4 to 11 mg/L on days 1–2, to 9 to 17 mg/L on days 6–7 of therapy. In 5 of these studies, the mean trough concentration was less than 10 mg/L for the first 48 hours of treatment. In 2 studies where a dose of 6 mg/kg/day was used, the mean concentrations did not exceed 10 mg/L until day 7, while in the other study they were greater than 10 mg/L beginning on day 1. A retrospective analysis of 58 clinical cases reported in the literature, 42 of whom had staphylococcal infections, indicated that serum concentrations and teicoplanin concentration/MIC ratios were related to clinical cure particularly for patients with staphylococcal infections. Trough concentrations of greater than 10 mg/L were related to favorable outcomes when all 58 patients were analyzed and trough concentrations of greater than 20 mg/L were related to cure for those who had staphylococcal infections.
While retrospective in nature, this review indicates that there is considerable variation in teicoplanin pharmacokinetics in the different patient groups, only some of which is related to differences in dosing, timing of blood collection for assay or assay methodology. In addition, these data suggest that pharmacokinetic parameters such as trough and postdose teicoplanin concentrations, and phamracodynamic factors such as serum concentration MIC ratios may be related to clinical outcome with teicoplanin therapy.
Similar content being viewed by others
References
Working Party Report of the British Society of Antimicrobial Chemotherapy. Chairman, Finch RG. The clinical evaluation of antimicrobial drugs. J Antimicrob Chemother 1989;23 (suppl B):1–42.
Cowling P, Rogers S, McMullin CM, White LO, Lovering AM, MacGowan AP, Reeves DS. The pharmacokinetics of lomefloxacin in elderly patients with urinary tract infections following daily dosing with 400 mg. J Antimicrob Chemother 1991;28:101–107.
Körner RJ, McMullin CM, Bowker KE, White LO, Holt HA, Reeves DS, MacGowan AP. The serum concentrations of desmethyl ofloxacin and ofloxacinN-oxide in seriously ill patients and their possible contributions to the antibacterial activity of ofloxacin. J Antimicrob Chemother 1994;34:300.
Lovering AM, Vickery CJ, Watkin DS, Leaper D, McMullin CM, White LO, et al. The pharmacokinetics of meropenem in surgical patients with moderate or severe infection. J Antimicrob Chemother 1995;36:165–172.
Moore RD, Letman PS, Smith CR. Clinical response to aminoglycoside therapy: importance of the ratio of peak concentration to minimum inhibitory concentration. J Infect Dis 1987;155:93–99.
Forrest A, Nix DE, Ballow CH, Gross TF, Birmingham MC, Shentag JJ. Pharmacodynamics of intravenous ciprofloxacin in seriously ill patients. Antimicrob Agents Chemother 1993;37:1073–1081.
Rowland M. Clinical pharmacokinetics of teicoplanin. Clin Pharmacokinet 1990;18:184–209.
MacGowan AP, McMullin CM, White LO, Reeves DS, Davies E, Speller DCE. Serum monitoring of teicoplanin. J Antimicrob Chemother 1992;30:399–402.
MacGowan AP, Lovering AM, White LO, Reeves DS. Why monitor peak vancomycin concentrations? Lancet 1995;345:645.
Reeves DS, MacGowan AP, Holt HA, Lovering AM, Warnock D, White LO. Therapeutic monitoring of antimicrobials: a summary of the information presented at the UK NEQAS for Antibiotic Assays Participants Meeting–October 1993. J Antimicrob Chemother 1995;35:213–226.
Contrepois A, Joly V, Abel L, Pangon B, Vallois JM, Carhon C. The pharmacokinetic and extravascular diffusion of teicoplanin in rabbits and comparative efficacy with vancomycin in an experimental endocarditis mode. J Antimicrob Chemother 1988;21:621–631.
Chambers HF, Kennedy S. Effects of dosage, peak and trough concentrations in serum, protein binding and bactericidal rate on efficacy of teicoplanin in a rabbit model of endocarditis. Antimicrob Agents Chemother 1990;34:510–514.
Cavenaghi L, Corti A, Cassani G. Comparison of the solid phase enzyme receptor assay (SPERA) and microbiological assay for teicoplanin. J Hosp Infect 1986;7(suppl A):85–89.
Patton KR, Beg A, Felmingham D, Ridgway GL, Grhneberg, RN. Determination of teicoplanin concentration in serum using a bioassay technique. Drugs Exp Clin Res 1987;13:547–550.
Jehl F, Monteil H, Tarral A. HPLC quantitation of the six main components of teicoplanin in biological fluids. J Antimicrob Chemother 1988;21(suppl A):53–59.
Rybak MJ, Bailey EM, Reddy VN. Clinical evaluation of teicoplanin fluorescence polarisation immunoassay. Antimicrob Agents Chemother 1991;35:1586–1590.
Cox H, Whitby M, Nimno G, Williams G. Evaluation of a novel fluorescence polarization immunoassay for teicoplanin. Antimicrob Agents Chemother 1993;37:1924–1926.
Kureishi A, Jewesson PJ, Barlett KH, Cole CD, Chow AW. Application of a modified bioassay for monitoring serum teicoplanin and vancomycin in febrile neutropenic patients. Antimicrob Agents Chemother 1990;34:1642–1647.
White LO, McMullin C, Davis AJ, MacGowan AP, Harding I, Reeves DS. The quality of clinical serum teicoplanin assays: an experimental European EQA distribution. Antimicrob Chemother 1996 (in press).
Glupczynski Y, Lagast H, Van der Auwera P, Thys JP, Crokaert F, Yourassowsky E, Meunier-Carpenter F, et al. Clinical evaluation of teicoplanin for therapy of severe infections caused by gram-positive bacteria. Antimicrob Agents Chemother 1986;29:52–57.
Kosmidis J, Kastanakis S, Kouroumalis E. Teicoplanin, a new glycopeptide antibiotic: in vitro activity, pharmacokinetic studies and therapeutic efficacy in gram-positive infections. Chemioterapia 1985;4:695–696.
Galanakis N, Giamarellou H, Avlami A, Kanellakopoulou K, Dendrinos CH, Daikos GK. Clinical microbiological and kinetic evaluation of teicoplanin. Chemioterapia 1985;4:682.
Calain P, Krause KH, Vaudaux P, Auckenthaler P, Lew D, Waldvogel F, Herschel B. Early termination of prospective randomised trial comparing teicoplanin and flucloxacillin for treating severe staphylococcal infections. J Infect Dis 1987;155:187–191.
Bochud-Gabellon I, Regamey C. Teicoplanin, a new antibiotic effective against gram-positive bacterial infections of the skin and soft tissues. Dermatologica 1988;176:29–38.
Galanakis N, Giamarellou M, Vlachogiannis N, Dendrios C, Diakos GK. Poor efficacy of teicoplanin in treatment of deep seated Staphylococcal infections. Eur J Clin Microbiol Infect Dis 1988;7:130–134.
Van der Auwera P, Aoun M, Meunier F. Randomised study of vancomycin versus teicoplanin for the treatment of gram-positive bacterial infections in immunocompromised hosts. Antimicrob Agents Chemother 1991;35:451–457.
Kureishi A, Jewesson PJ, Rubinger M, Cole CD, Reece DA, Phillips GL, et al. Double-blind comparison of teicoplanin versus vancomycin in febrile neutropenic patients receiving concomitant tobramycin and piperacillin: effect on cyclosporin A-associated nephrotoxicity. Antimicrob Agents Chemother 1991;35:2246–2252.
Chárbonneau P, Harding I, Garaud JJ, Aubertin J, Burnet F, Domart Y. Teicoplanin: a well tolerated and easily administered alternative to vancomycin for Gram-positive infections in intensive care patients. Intensive Care Med 1994;20:S35-S42.
Bibler MR, Frame PT, Hagler DN, Bode RB, Staneck JL, Thamlikitkul V, Harris JE, Haregewoin A, Bullock WE. Clinical evaluation of efficacy, pharmacokinetics and safety of teicoplanin for serious gram-positive infections. Antimicrob Agents Chemother 1987;31:207–212.
Stille W, Sietzen W, Dieterich HA, Fell JJ. Clinical efficacy and safety of teicoplanin. J Antimicrob Chemother 1988;21(suppl A):69–79.
Potel G, Touze MD, Meignier M, Reynaud A, Baron D. Efficacité de la teicplanine dans vingt-cinq infections severes a cocci gram positif. Pathologica Biologica 1988;36:531–535.
Novakova IRO, Donnelly JP, Stans Verhagen C, De Pauw BE. Teicoplanin as modification of initial empirical therapy in febrile granulocytopenic patients. J Antimicrob Chemother 1990;25:985–993.
Novakova I, Donnelly PJ, De Pauw B. Ceftazidime as monotherapy or combined with teicoplanin for initial empiric treatment of presumed bacteraemia in febrile granulocytopenic patients. Antimicrob Agents Chemother 1991;35:672–678.
Dureux JB, Canton P, Chavanet P, Chippaux C, Dupeyron JP, Estavoyer JM, et al. Teicoplanine et Infections a cocci a Gram positif. Pathologica Biologica 1987;35:511–515.
Fauser AA, Lang E, Dolken G, Bross KJ, Schmid J, Sorgel F. Treatment of severe sepsis in bone marrow transplant recipients with teicoplanin in combination with β lactams and aminoglycosides. Infection 1991;3:195–200.
Peny AM, Vergnaud M, Peny J, Morel C, Malbruny B. Surveillance des taux seriques de teicoplanine administree au cours d'episodes febriles chez des adultes en aplastic severe pour autogreffe de moelle osseuse. 11th Interdisciplinary Meeting on Anti-Infectious Chemotherapy, 1991 (abstr 113).
De Lalla F, Rinaldi E, Santoro D, Rizzardini G, Martello P, Gualianone MH. Teicoplanin in the therapy of Grampositive infection: an open non-randomised study. J Chemother 1989;1(suppl 4):719–721.
Martino P, Venditti M, Micozzi A, Brandimarte C, Gentile G, Santani C, Serra P. Teicoplanin in the treatment of Gram positive bactericeae endocarditis. Antimicrob Agents Chemother 1989;33:1329–1334.
Greenberg RN. Treatment of bone joint and vascular-access-associated gram-positive bacterial infection with teicoplanin. Antimicrob Agents Chemother 1990;34:2392–2397.
Kempf P, Pompetzki H, Oppermann A, Wittenberger R, Siebert J, Fell JJ, et al. Clinical efficacy and safety of teicoplanin in the treatment of gram-positive infections. Infection 1989;3:177–181.
Peterson D, Steffen A, Bautsch W, Ziesing S, Link H. Therapeutic drug monitoring and in-vitro activity of the glycopeptide antibiotic teicoplanin. Ther Drug Monit 1993;15:141.
Van Laethem V, Hermans P, De Wit S, Goosens H, Clumeck N. Teicoplanin compared with vancomycin in methicillin-resistantStaphylococcus aureus infections: preliminary results. J Antimicrob Chemother 1980;21(suppl A):81–87.
Gilbert DN, Wood CA, Kimbrough RC & Infectious Diseases Consortium of Oregon. Failure of treatment with teicoplanin at 6 milligrams/kilogram/day in patients withStaphylococcus aureus intravascular infection. Antimicrob Agents Chemother 1991;35:79–87.
Leport C, Perronne C, Massip P, Canton P, Leclercq P, Bernard E, et al. Evaluation of teicoplanin for treatment of endocarditis caused by Gram-positive cocci in 20 patients. Antimicrob Agents Chemother 1989;33:871–876.
Wilson APR, Gruneberg RN, Neu H. Dosage recommendations for teicoplanin. J Antimicrob Chemother 1993;32:792–796.
Ryback MJ, Albrecht LM, Berman JR, Warbase LH, Svensson CK. Vancomycin pharmacokinetics in burn patients and intravenous drug abusers. Antimicrob Agents Chemother 1990;34:792–795.
Soto J, Alsar MJ, Chantal P, Sacristan JA. Correlation of vancomycin clearance and creatinine clearance: unreliability for predicting initial dosing in neutropenic haematological patients. J Antimicrob Chemother 1993;32:920–922.
MacGowan AP, Bedford KA, Blundell E, Brown NM, Habib F, Kirkpatrick B. The pharmacokinetics of oncedaily gentamicin in neutropenic adults with haematological malignancy. J Antimicrob Chemother 1994;34:809–812.
Flexner C, van der Horst C, Jacobson MA, Powderly W, Duncanson F, Ganes D, et al. Relationship between plasma concentrations of 3′-deoxy-3′ fluorothymidine (alorudine) and anti retroviral activity in two concentration controlled trials. J Infect Dis 1994;170:1394–1403.
MacGowan AP. Concentration controlled and concentration defined clinical trials: do they offer any advantages for antimicrobial chemotherapy. J Antimicrob Chemother 1996;37:1–5.
Wilson APR, Gruneberg RN, Neu H. A critical review of the dosage of teicoplanin in Europe and the USA. Int J Antimicrob Agents 1994;4(suppl 1):S1-S30.
Lewis P, Garaud J-J, Parenti F. A multicentre open clinical trial of teicoplanin in infections caused by Gram-positive bacteria. J Antimicrob Chemother 1988;21:(suppl A):61–67.
Author information
Authors and Affiliations
About this article
Cite this article
MacGowan, A., White, L., Reeves, D. et al. Retrospective review of serum teicoplanin concentrations in clinical trials and their relationship to clinical outcome. J Infect Chemother 2, 197–208 (1996). https://doi.org/10.1007/BF02355116
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02355116