Teicoplanin


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : PO Clostridium difficile-associated diarrhoea and colitis 100-200 mg bid for 7-14 days. IV Continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis 6 mg/kg as single loading dose. Teicoplanin is added to the dialysis solution at a concentration of 20 mg/L; dose is added into each bag of solution in the 1st week, followed by alternate bags in the 2nd week and then in the overnight dwell bag in the 3rd week. IV/IM Complicated skin and soft tissue infections; Pneumonia; Complicated urinary tract infections Combined with other antibacterial: Initial: 6 mg/kg via IM inj or via IV bolus over 3-5 minutes or infused over 30 minutes every 12 hours for 3 doses. Maintenance: 6 mg/kg once daily to achieve targeted trough concentration (refer to detailed product guideline). Treatment duration is adjusted according to type and severity of infection and patient clinical response. Max: 4 months. Bone and joint infections; Infective endocarditis Combined with other antibacterial: Initial: 12 mg/kg via IM inj or  via IV bolus over 3-5 minutes or infused over 30 minutes every 12 hours for 3-5 doses. Maintenance: 12 mg/kg once daily to achieve targeted trough concentration (refer to detailed product guideline). Treatment duration is adjusted according to type and severity of infection and patient clinical response. Max: 4 months.
Dosage Details
Intravenous
Continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis
Adult: 6 mg/kg as single loading dose. Teicoplanin is added to the dialysis solution at a concentration of 20 mg/L; dose is added into each bag of solution in the 1st week, followed by alternate bags in the 2nd week and then in the overnight dwell bag in the 3rd week.
Child: ≤2 months Loading dose: 16 mg/kg via infusion on day 1. Maintenance: 8 mg/kg via infusion once daily. 2 months to 12 years Loading dose: 10 mg/kg every 12 hours for 3 doses. Maintenance: 6-10 mg/kg once daily. >12 years Same as adult dose.

Oral
Clostridium difficile-associated colitis, Clostridium difficile-associated diarrhoea
Adult: 100-200 mg bid for 7-14 days.

Parenteral
Complicated skin and soft tissue infections, Complicated urinary tract infections, Pneumonia
Adult: In combination with other antibacterial: Initially, 6 mg/kg via IM inj or  via IV bolus over 3-5 minutes or infused over 30 minutes every 12 hours for 3 doses. Maintenance: 6 mg/kg once daily to achieve targeted trough concentration (refer to detailed product guideline). Treatment duration is adjusted according to type and severity of infection and patient clinical response. Max: 4 months.
Child: ≤2 months Loading dose: 16 mg/kg via  infusion on day 1. Maintenance: 8 mg/kg via infusion once daily. 2 months to 12 years Loading dose: 10 mg/kg via IV inj every 12 hours for 3 doses. Maintenance: 6-10 mg/kg via IV inj once daily. >12 years Same as adult dose.

Parenteral
Bone and joint infections, Infective endocarditis
Adult: In combination with other antibacterial: Initially, 12 mg/kg via IM inj or  via IV bolus over 3-5 minutes or infused over 30 minutes every 12 hours for 3-5 doses. Maintenance: 12 mg/kg once daily to achieve targeted trough concentration (refer to detailed product guideline). Treatment duration is adjusted according to type and severity of infection and patient clinical response. Max: 4 months.
Child: ≤2 months Loading dose: 16 mg/kg via  infusion on day 1. Maintenance: 8 mg/kg via infusion once daily. 2 months to 12 years Loading dose: 10 mg/kg every 12 hours for 3 doses. Maintenance: 6-10 mg/kg once daily. >12 years Same as adult dose.
Renal Impairment
Parenteral:
Usual dose to be given for first 3 days, thereafter adjust dose according to CrCl. Patient on haemodialysis: 1/3 of the usual dose given once daily.
CrCl (mL/min) Dosage
30-80 Maintenance: 1/2 of the usual dose given once daily.
<30 1/3 of the usual dose given once daily.
Reconstitution
Reconstitute vial labelled as containing 200 and 400 mg with 3.14 mL of sterile water for injection. Gently rotate until the powder is dissolved; Reconstituted solution may be further diluted with suitable infusion solution.
Incompatibility
Incompatible with aminoglycosides solutions.
Contraindications
Hypersensitivity.
Special Precautions
Patient with history of red-man syndrome. Renal impairment. Elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Thrombocytopenia, ototoxicity (deafness, tinnitus), renal failure, superinfection, red man syndrome manifested as pruritus, urticaria, erythema, angioneurotic oedema, tachycardia, hypotension, dyspnea.
Blood and lymphatic system disorders: Leucopenia, eosinophilia, agranulocytosis, neutropenia.
Gastrointestinal disorders: Diarrhoea, nausea, vomiting.
General disorders and administration site conditions: Pain, pyrexia, injection site abscess.
Infections and infestations: Abscess, superinfection.
Investigations: Transaminases increased, blood alkaline phosphatase increased, blood creatinine increased.
Nervous system disorders: Dizziness, headache, seizures.
Renal and urinary disorders: Blood creatinine increased.
Respiratory, thoracic and mediastinal disorders: Bronchospasm.
Skin and subcutaneous tissue disorders: Rash, erythema, pruritus, dermatitis exfoliative.
Vascular disorders: Phlebitis, thrombophlebitis.
Potentially Fatal: Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), hypersensitivity reactions (e.g. anaphylactic shock).
Patient Counseling Information
This medicine may cause dizziness and headache, if affected, do not drive or operate machinery.
MonitoringParameters
Monitor trough concentration at steady state after loading dose, and at least once a week during maintenance treatment. Perform culture and susceptibility tests before treatment initiation. Monitor CBC, liver and kidney function test.
Overdosage
Symptoms: Agitation (newborn). Management: Supportive and symptomatic treatment.
Drug Interactions
Increased nephrotoxic effect with aminoglycosides, ciclosporin, cisplatin. Increased ototoxic effects with furosemide, ethacrynic acid.
Potentially Fatal: Crossed hypersensitivity reactions with vancomycin.
Action
Description: Teicoplanin, a glycopeptide antibiotic which inhibits growth of susceptible organisms by interfering with cell-wall synthesis. It blocks peptidoglycan synthesis by binding to D-alanyl-D-alanine residues.
Pharmacokinetics:
Absorption: Not absorbed from the gastrointestinal tract. Bioavailability: 90% (IM).
Distribution: Distributed mainly in lung, myocardium and bone tissues. Volume of distribution: 0.7-1.4 L/kg. Plasma protein binding: Approx 87.6-90.8%.
Metabolism: Minimally metabolised via hydroxylation.
Excretion: Mainly via urine (approx 80%); faeces (approx 2.7% as unchanged drug) when administered oral. Elimination half-life: 100-170 hours.
Chemical Structure

Chemical Structure Image
Teicoplanin

Source: National Center for Biotechnology Information. PubChem Database. Teichomycin, CID=16131923, https://pubchem.ncbi.nlm.nih.gov/compound/Teichomycin (accessed on Jan. 23, 2020)

Storage
Store below 30°C. Protect from light. Reconstituted solution: Store between 2-8°C.
MIMS Class
References
Anon. Teicoplanin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 17/06/2019.

Buckingham R (ed). Teicoplanin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 17/06/2019.

Joint Formulary Committee. Teicoplanin. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 17/06/2019.

Disclaimer: This information is independently developed by MIMS based on Teicoplanin from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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