A CRITICAL-REVIEW OF THE DOSAGE OF TEICOPLANIN IN EUROPE AND THE USA

The glycopeptide antibiotic, teicoplanin, is increasingly used in Euro pe in the treatment of Gram-positive infection. It is administered as a bolus once daily, it has little potential for nephrotoxicity, and se rum monitoring is usually unnecessary. However, poor results were repo rted in early trials at a daily dose of 200 mg and, more recently, at 400 mg/day in monotherapy of staphylococcal endocarditis. While 400 mg (6 mg/kg day-1) is now standard, US trials have tried very high doses in an attempt to improve its efficacy in monotherapy of deep-seated s taphylococcal sepsis. European centres continue to use 6 mg/kg day-1 a s the usual maintenance dose and 6-12 mg/kg as the loading dose. For t he more difficult cases, teicoplanin is used in combination with other agents. All available published and unpublished literature was review ed to try to solve these problems. With the exception of endocarditis, failure rates in the 84 European open studies varied more between tri als than between the dosages used. In 32 European and eight US randomi zed trials, a dose of 6 mg/kg day-1 of teicoplanin was effective, exce pt in staphylococcal endocarditis if teicoplanin was used as monothera py. In that case, 12 mg/kg day-1 or more was needed to achieve a cure rate similar to that of vancomycin. Treatment was most successful with trough levels over 20 mg/l. However, lower doses were effective in co mbination with aminoglycosides, as is common in clinical practice. An open trial suggested that 12 mg/kg day-1 was needed for treatment of s eptic arthritis. It is suggested that 6 mg/kg day-1 of teicoplanin be used for all indications except staphylococcal endocarditis and septic arthritis when it should be given in a dose of 12 mg/kg day-1 or in c ombination with other agents.