Clinical Pharmacology of Teicoplanin in Neonates: Effects and Pharmacokinetics

Teicoplanin is a glycoside antibiotic which consists of five closely related glycopeptide antibiotics with similar antibacterial properties to vancomycin that were first isolated in 1976. Teicoplanin is active against many gram-positive anaerobe microorganisms and is particularly potent against clostridium species. It is also active against most Listeria, enterococci and staphylococci including methicillin-resistant strains. Nonviridans and viridans streptococci, Streptococcus pneumoniae, and enterococci are inhibited by teicoplanin. Teicoplanin has been used to treat a wide variety of infections, including osteomyelitis and endocarditis caused by methicillin-resistant and methicillin-susceptible staphylococci, streptococci, and enterococci. Teicoplanin has a spectrum of antimicrobial action similar to vancomycin, but teicoplanin has some advantages in that it only needs to be given once a day, does not need to be given as slowly as vancomycin and can be given by intramuscular injection. Teicoplanin cannot be given by mouth. Teicoplanin is excreted unchanged in the urine. The half-life of teicoplanin is 100 hours in adults and 21/2 days in children. Teicoplanin has a large distribution volume and long half-life and a loading dose is recommended. In infants, the loading dose of teicoplanin is 16 mg/kg administered intravenously followed by 8 mg/kg once daily. The target trough concentration of teicoplanin ranges from 15 to 30 µg/ml. The incidence of hepatic dysfunction, renal impairment and thrombocytopenia is 14.8%, 20%, and 14%, respectively, when the serum teicoplanin concentrations range from < 20 µg/ml and ≥ 20 µg/ml. The aim of this study is to review the effects and the pharmacokinetics of teicoplanin in neonates.