USE OF TEICOPLANIN IN PRETERM NEONATES WITH STAPHYLOCOCCAL LATE-ONSETNEONATAL SEPSIS

Objective: To study the clinical pharmacology of teicoplanin in babies admitted to a newborn intensive care unit, by monitoring serum levels , efficacy and potential side effects. Methods: An open, nonrandomized descriptive study was performed in the neonatal intensive and high ca re unit of the University Hospital Maastricht, The Neterlands. Twenty- three preterm neonates, gestational age ranging from 26 to 32 weeks (m edian 28.4 weeks), postnatal age from 5 to 47 days, and birth weight f rom 570 to 1,740 g, presenting with (suspected) late onset septicemia, were studied. Of 21 culture-proven septicemias, 20 were caused by sta phylococci. The teicoplanin loading dose was 15 mg/kg i.v., followed b y a maintenance dose of 8 mg/kg every 24 h. Intravenous gentamicin was also administered pending blood culture. Serum teicoplanin concentrat ions were measured by fluorescence polarization immunoassay. Clinical and microbiological cure/failure rates were determined and possible si de effects were monitored. Results: The study of individual pharmacoki netics during multiple-dose intravenous infusions was rendered impossi ble by apparently inaccurate dosing. Peak (30 min after end of the inf usion) and trough teicoplanin levels were stable throughout the study and averaged 27.8 (interquartile range 23.7-32.9) and 12.3 (interquart ile range 9.1-16.8) mg/l, respectively. The microbiological and clinic al cure rates were 90% in gram-positive septicemia. There was no appar ent toxicity. Conclusions: Inaccurate drug administration was a proble m in this study, making a multidose pharmacokinetic study impossible. It is possible that inaccurate drug administration and not current dos age guidelines yielded trough levels below 10 mg/l in 57 (32%) of 176 instances. This pharmaceutical aspect clearly warrants further study. However, microbiological and clinical cure rates were high in gram-pos itive septicemias, No side effects attributable to teicoplanin therapy were encountered.