J Korean Med Sci.  2020 Dec;35(46):e376. 10.3346/jkms.2020.35.e376.

Therapeutic Drug Level Monitoring of Teicoplanin in Korean Pediatric Patients with Normal versus Impaired Renal Function

• Choi Js
• Kim JM
• Kim D
• Kim SH
• Cho H
• Park HD
• Lee SY
• Kang CI
• Kim YJ

• KMID: 2509035
• DOI: http://doi.org/10.3346/jkms.2020.35.e376

Abstract

Background
Teicoplanin is used to treat serious gram-positive infections. Optimal teicoplanin trough levels are considered to be ≥ 10 μg/mL. Despite its wide use in various clinical settings, data on teicoplanin trough level in pediatric patients are limited. Therefore, the aim of this study was to investigate the therapeutic drug level monitoring of teicoplanin in Korean pediatric patients, including those with impaired renal function.
Methods
A retrospective study was performed in pediatric patients (age ≤ 18 years old) who received teicoplanin from September 2014 to April 2018. The regimen included a loading dose of 10 mg/kg/dose at 12 hours' interval three times in a row, and a maintenance dose of 10 mg/kg/dose commenced at 24 hours of interval after the loading dose, with a maximum of 400 mg/dose, respectively. The first therapeutic drug levels were measured. Distribution and characteristics of trough levels in patients with decreased renal function and those with bacteremia were also assessed.
Results
A total of 187 trough levels were collected from 143 patients. Hematologic and oncologic diseases were the most common underlying diseases (83.2%, n = 119). One hundred eighty trough levels were first measured, and their median value was 16.2 μg/mL (range, 2.3–100 μg/mL) and the median interval between initial teicoplanin injection and 1st trough level was 96.5 hours (range 47.6–179.3 hours). Lower steady-state levels were observed in younger age group (median, 13.5 vs. 18.0 μg/mL, P = 0.038). Median trough levels were higher in patients with decreased renal functions (P < 0.001). In addition, among eight with gram-positive bacteremia, seven of them had a favorable outcome.
Conclusion
This study provides additive information on trough level monitoring of teicoplanin in children with impaired renal function and treatment effect in patients with gram-positive bacteremia. Careful monitoring for steady state trough levels of teicoplanin is warranted.

Keyword

Teicoplanin; Therapeutic Drug Level Monitoring; Children; Impaired Renal Function; Bacteremia

Figure

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  Fig. 1 Steady state trough levels: decreased vs. normal renal function.Differences in steady state trough levels between patients with decreased renal function and those with normal renal function. Decreased renal function was defined as eGFR less than 70 mL/min/BSA, calculated with modified Schwartz equation.BSA = body surface area, eGFR = estimated glomerular filtration rate.aMedian (range).

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