Monitoring teicoplanin blood concentrations

Teicoplanin plasma concentration monitoring is routinely recommended and is particularly important for patients with methicillin-resistant Staphylococcus aureus (MRSA) infections. Studies have shown that there is significant pharmacokinetic variability, leading to differences in clinical outcomes.

Evidence supports using the area under the concentration–time curve over a 24-hour period (AUC₂₄) to the minimum inhibitory concentration (MIC) ratio (AUC₂₄/MIC) to monitor the efficacy of teicoplanin; however, this is may not be practical as it may be difficult to obtain multiple plasma concentrations and calculate the AUC₂₄. Evidence has been extrapolated from other antimicrobials to show that the trough concentration can be used as a surrogate for AUC₂₄Hanai 2021Ramos-Martin 2017.

Generally, the teicoplanin plasma concentration is measured after 4 to 5 days of therapyHanai 2021. Optimum efficacy for MRSA infections with teicoplanin is achieved when the total (bound and unbound) trough concentration is more than 15 mg/L. A higher trough concentration of between 20 to 50 mg/L is required in patients with severe, deep-seated infections (eg endocarditis, osteomyelitis); treatment failures have been reported in MRSA endocarditis with teicoplanin trough concentrations less than 20 mg/LHanai 2021Seki 2012Wilson 1991.

Teicoplanin is highly protein bound; therefore, the unbound teicoplanin concentration should be measured in patients with hypoalbuminaemia or patients who are critically ill. The suggested unbound teicoplanin trough plasma concentration is between 1.5 and 3 mg/L.