JAC Advance Access published online on February 25, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg147
© 2003 by The British Society for Antimicrobial Chemotherapy
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Original article
1 Institute of Clinical
Pharmacology & Toxicology, Department of Experimental and
Clinical Pathology
and Medicine, Medical School, University of Udine, P.le S. Maria
della Misericordia 3, 33100 Udine
* Corresponding author. E-mail: federico.pea{at}med.uniud.it.
Received 18 September 2002
; revised 5 November 2002
; accepted 11 January 2003
Data obtained as part of our routine drug monitoring
of teicoplanin therapy (therapeutic drug monitoring, TDM) in adult critically
ill patients being treated for suspected or documented Gram-positive
multiresistant infections were assessed, retrospectively. Data were
available for 202 patients (146 male, 56 female; age 58 ± 16
years) with a total number of 829 teicoplanin trough plasma levels
(Cmin) assessed. The percentage of patients
with adequate teicoplanin concentrations (Cmin
Keywords: teicoplanin, TDM, loading dose, renal function,
hypoalbuminaemia
Teicoplanin therapeutic drug monitoring in critically
ill patients: a retrospective study emphasizing the importance of
a loading dose
2 Institute of Infectious Diseases,
Department of Medical and Morphological Research, Medical School,
University of Udine, Udine, Italy
10 mg/L) during the treatment period
substantially increased from 3.2% on day 2, to 35%,
70%, 90% and 
95% on
days 4, 7, 11 and 15, respectively. The findings suggest that optimal teicoplanin
therapy was achieved only after at least 4, and probably 7, days
of therapy in most cases, mainly because of a failure to use an
appropriate loading dose. Among the possible causes for the reluctance
to use a loading dose, concern over the potential nephrotoxicity
of teicoplanin was a major factor. We conclude that loading doses
of teicoplanin (6 mg/kg every 12 h for at least three doses)
must be considered mandatory in all patients, regardless of their
renal function, to enable optimal drug concentrations to be achieved
early in the treatment period. Subsequently, TDM is important to
ensure that dose regimens are optimized to the individual requirements
of the patients.
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