Is Therapeutic Drug Monitoring of Teicoplanin Useful?

which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Editorial Vancomycin and teicoplanin are the glycopeptides currently in use for the treatment of infections caused by beta-lactam-resistant gram-positive organisms [1]. Teicoplanin, a glycopeptide antibiotic, has a lower possibility than vancomycin to cause re-nal toxicity, and causes fewer anaphylactoid reactions [2]. Tei-coplanin has been found to be comparable to vancomycin in efficacy [1]. As teicoplanin can be administered once daily in-tramuscularly as well as intravenously, it can be used for outpatient therapy of methicillin-resistant staphylococcal infections [1]. Teicoplanin completely excreted unchanged in the urine by glomerular filtration, and doses should be reduced appropriately in patients with renal dysfunction. Its pharma-cokinetics include a prolonged terminal half-life of 150 to 180 h, which is important during long-term therapy [1]. Usual dose and dosing interval of teicoplanin for IV injection or infusion consist initially 400 mg every 12 hours for 3 doses and subsequently 200 mg once daily (400 mg once daily for severe infections) [1, 3]. Higher doses are recommended in patients over 85 kg, or in severe burns or methicillin-resistant Staphylococcus aureus (MRSA) infection [1, 3]. For strepto-coccal endocarditis, initially 6 mg/kg every 12 hours for 3 doses , then 6 mg/kg once daily are typical [1, 3]. For enterococcal endocarditis, initially 10 mg/kg every 12 hours for 3 doses, then 10 mg/kg once daily are standard. For child, initially 10 mg/kg every 12 hours for 3 doses, subsequently 6 mg/kg once daily (10 mg/kg once daily for severe infections or in neutro-penia) is a typical regimen [1, 3]. Vancomycin level monitoring is common in the hospitals with increasing minimal inhibitory concentration (MIC) of S. aureus ("MIC creep") [1]. For complicated infections (bactere-mia, endocarditis, osteomyelitis, meningitis, and hospital-acquired pneumonia) and for infections caused by strains with MICs of >1 μg/mL, trough levels of 15 to 20 μg/mL are recommended [1]. Larger vancomycin doses are associated with increased nephrotoxicity [1], and monitoring of vancomycin trough serum levels is recommended in the view of avoiding nephrotoxicity [4]. Therapeutic drug monitoring (TDM) of teicoplanin is not routine because of the lack of evidence for dose-related adverse effects of teicoplanin [3]. However, measuring of teicoplanin plasma concentrations may help to optimize therapy in some patients. Data of teicoplainin TDM are largely lacking [1]. Hard-ing et al. [5] reported the probability of successful treatment increased with mean pre-dose …