Retrospective analysis of relationships among the dose regimen, trough concentration, efficacy, and safety of teicoplanin in Chinese patients with moderate-severe Gram-positive infections

Lijuan Zhou; Yanqiu Gao; Wei Cao; Jia Liu; Hongya Guan; Hua Zhang; Yun Shi; Wenying Lv; Long Cheng

doi:10.2147/IDR.S146961

Retrospective analysis of relationships among the dose regimen, trough concentration, efficacy, and safety of teicoplanin in Chinese patients with moderate-severe Gram-positive infections

Infect Drug Resist. 2018 Jan 5:11:29-36. doi: 10.2147/IDR.S146961. eCollection 2018.

Authors

Lijuan Zhou^#¹, Yanqiu Gao², Wei Cao¹, Jia Liu¹, Hongya Guan¹, Hua Zhang², Yun Shi³, Wenying Lv⁴, Long Cheng^#⁵

Affiliations

¹ Translational Medicine Center.
² Department of Respiratory Medicine, Affiliated Zhengzhou Central Hospital of Zhengzhou University, Zhengzhou.
³ Department of Gynecology, Dongzhimen Hospital, Beijing University of Chinese Medicine.
⁴ Chaoyangmen Community Health Service Center.
⁵ Key Laboratory of Bioactive Substances and Resources Utilization of Chinese Herbal Medicine, Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.

^# Contributed equally.

Abstract

Objectives: Teicoplanin, an antibiotic, has poor clinical efficacy when using the current drug label's recommended regimen, which is approved by the China Food and Drug Administration. This study explores the appropriate loading and maintenance doses of teicoplanin and evaluates the therapeutic target of teicoplanin trough concentration (minimum concentration [C_min]).

Subjects and methods: All patients treated with teicoplanin from February 2015 to August 2016 at Zhengzhou Central Hospital were screened for enrollment. A total of 113 subjects were included and then divided into four groups: A (received three to six doses at a loading dose of 400 mg at 12-hour intervals, followed by maintenance dosing of 400 mg/day), B (received three doses at a loading dose of 400 mg at 12-hour intervals, followed by maintenance dosing of 400 mg/day), C (received two doses at a loading dose of 400 mg at 12-hour intervals, followed by maintenance dosing of 200 mg/day), and D (received one to three doses at a loading dose of 400 mg at 12-hour intervals, followed by maintenance dosing of 200 mg/day). C_min values of teicoplanin were detected with high-performance liquid chromatography on day 4, 30 minutes before maintenance-dose administration. Teicoplanin C_min, efficacy, and safety were compared among the four groups.

Results: Mean C_min differed significantly among the four groups (A, 18.11±6.37 mg/L; B, 15.91±4.94 mg/L; C, 17.06±5.66 mg/L; D, 11.97±3.76 mg/L) (P<0.001), with creatinine clearance of 89.62 (53.72-162.48), 49.66 (40.69-59.64), 27.17 (9.7-39.45), and 96.6 (17.63-394.73) mL/min, respectively. The ratio of loading dose for 3 days to creatinine clearance and serum C_min were significantly correlated (R=0.59, P<0.001). The correlation between the estimated probability of success and teicoplanin C_min was assessed using binary logistic regression (OR 2.049, P<0.001). Hepatotoxicity- and nephrotoxicity-incidence rates did not significantly differ among the four groups (P=0.859 and P=0.949, respectively).

Conclusion: A loading dose of 400 mg at 12-hour intervals three to six times is needed to achieve the early target range (15-20 mg/L) and improve the clinical efficacy rate for normal-renal-function patients. It is urgently necessary to amend the drug label for the recommended regimen.

Keywords: Chinese drug label; efficacy; loading dose; safety; serum trough concentration; teicoplanin.