Dose Optimization of Teicoplanin for Critically Ill Patients With Renal Dysfunction and Continuous Renal Replacement Therapy: Experience From a Prospective Interventional Study

Lu Shi; Zhiwei Zhuang; Lufen Duan; Chenqi Zhu; Hongzhi Xue; Xiao Wang; Xiaowen Xu; Yunlong Yuan; Ling Shi; Jiahui Li; Jiantong Sun; Xin Liu; Qin Zhou; Jian Lu; Lian Tang

doi:10.3389/fphar.2022.817401

Dose Optimization of Teicoplanin for Critically Ill Patients With Renal Dysfunction and Continuous Renal Replacement Therapy: Experience From a Prospective Interventional Study

Front Pharmacol. 2022 Mar 8:13:817401. doi: 10.3389/fphar.2022.817401. eCollection 2022.

Authors

Lu Shi¹, Zhiwei Zhuang², Lufen Duan¹, Chenqi Zhu¹, Hongzhi Xue¹, Xiao Wang³, Xiaowen Xu², Yunlong Yuan⁴, Ling Shi¹, Jiahui Li¹, Jiantong Sun¹, Xin Liu¹, Qin Zhou¹, Jian Lu³, Lian Tang¹

Affiliations

¹ Department of Pharmacy, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China.
² Emergent Intensive Care Unit, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China.
³ Intensive Care Unit, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China.
⁴ Medical Laboratory, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China.

Abstract

Background: Due to the lack of updated information on teicoplanin (TEI) for continuous renal replacement therapy (CRRT), no exact dosage regimen has been recommended. The aim of this study was to optimize the dosage regimen of TEI in renal dysfunction patients with or without CRRT, evaluate the influence factors of the eradication of Gram-positive bacteria, and evaluate the effect of CRRT on the clearance of TEI. Methods: Patients with renal dysfunction receiving TEI treatment in the ICU were prospectively recruited and divided into CRRT and non-CRRT groups. Logistic regression analysis was used to screen the factors affecting the eradication of Gram-positive bacteria. The filtrate concentration of the CRRT group was measured at the time of TEI C_min, and the filtration coefficient of TEI was calculated to evaluate the effect of CRRT on the clearance of TEI. Results: A total of 106 patients were included, 40 cases in the CRRT group and 66 cases in the non-CRRT group. After giving high-loading doses of TEI, 75.8 and 70% of TEI C_min in the non-CRRT and CRRT groups reached the range of 10-30 mg/L before the 3rd dose, respectively. The risk of G⁺ bacteria being uneradicated was higher while the APACHEⅡscore was higher than 22.5. The albumin level before the start of TEI administration and before the 6th-8th dose was lower than 32.8 g/L and 29.3 g/L, respectively, and C_min before the 3rd dose and 6th-8th dose was lower than 13.2 mg/L and 17.1 mg/L, respectively, with the duration of TEI therapy shorter than 10.5 days. The correlation coefficient (r) was 0.6490 between C_min before the 3rd dose and the albumin level (p < 0.001). The filtration coefficient of TEI was 10.7 ± 2.4% at C_min and 11.1 ± 2.5% at C_max. The GFR had no correlation with the filtration coefficient (r = -0.06204; r = -0.08059). The clearance of TEI in CRRT patients was negatively correlated with the albumin level (r = -0.6305, p = 0.0013). Conclusion: The early stage of the albumin level can significantly affect the initial C_min and clinical efficacy of TEI, and also had effect on the clearance of TEI by CRRT. The filtration coefficient of TEI was stable, even with a higher ultrafiltration rate.

Keywords: albumin; continuous renal replacement therapy; filtration coefficient; high loading dose; renal dysfunction; teicoplanin; therapeutic drug monitoring.