MONITORING OF TEICOPLANIN IN A MAJOR BURN PATIENT

The authors report the study of the kinetics in serum and urine and th e clinical safety of a high dose of teicoplanin administered in a 19 y ear-old patient with major burns (60% of body surface area, the half o f which consisting of third-degree burns and UBS at 150) and S aureus meticillin-resistant infection. At day 1, he was given two loading inf usions of 12 mg.kg(-1) teicoplanin followed by 12 mg.kg(-1) per day of treatment. At all times, C-min concentrations were below the limit va lue of 8 mg.mL(-1). Therefore the therapeutic regimen was increased on several occasions. On days 5, 8 and 15, C-min were measured by FPIA. Pharmacokinetic analysis was performed at day 16, (ie, 20 mg.kg(-1)) a nd urine was also collected over at least 12 hours. At day 16, serum a nd urine samples were assayed by HPLC. Data were analyzed with a nonco mpartmental method. The duration of treatment was 20 days and no adver se events were noted. Bacteriological tests performed at the end of tr eatment demonstrated the elimination of the agent responsible over the infection, While pharmacokinetics were not assessed at plateau, C-min remained very low. V-ss was similar to values obtained in healthy sub jects while total clearance was increased. This phenomenon was explain ed by the increase of total clearance and a nonrenal translesional dif fusion suggested by the body surface area affected by third-degree bur ns. Finally, the cost of increasing doses of teicoplanin must be taken in account.