Adult: In combination with other antibacterial agents: Loading dose: 6 mg/kg 12 hourly for 3 doses. Maintenance: 6 mg/kg once daily, may be adjusted based on the desired target trough concentrations (refer to detailed product guidelines). All doses may be given via IV inj over 3-5 minutes, IV infusion over 30 minutes or via IM inj. Treatment duration must be adjusted according to the type and severity of infection and the patient’s clinical response. Max treatment duration: 4 months. Child: ≤2 months Loading dose: 16 mg/kg as a single dose on Day 1. Maintenance: 8 mg/kg once daily starting on Day 2. Doses are given only via IV infusion over 30 minutes; 2 months to 12 years Loading dose: 10 mg/kg 12 hourly for 3 doses. Maintenance: 6-10 mg/kg once daily. Doses are administered via IV inj over 3-5 minutes or IV infusion over 30 minutes; >12 years Same as adult dose.
Intramuscular, Intravenous Bone and joint infections, Infective endocarditis
Adult: In combination with other antibacterial agents: Loading dose: 12 mg/kg 12 hourly for 3-5 doses via IV inj over 3-5 minutes or IV infusion over 30 minutes. Maintenance: 12 mg/kg once daily via IV inj over 3-5 minutes, IV infusion over 30 minutes or via IM inj; may be adjusted based on the desired target trough concentrations (refer to detailed product guidelines). Treatment duration must be adjusted according to the type and severity of infection and the patient’s clinical response. Minimum treatment duration for infective endocarditis: 21 days. Max treatment duration: 4 months. Child: ≤2 months Loading dose: 16 mg/kg as a single dose on Day 1. Maintenance: 8 mg/kg once daily starting on Day 2. Doses are given only via IV infusion over 30 minutes; 2 months to 12 years Loading dose: 10 mg/kg 12 hourly for 3 doses. Maintenance: 6-10 mg/kg once daily. Doses are administered via IV inj over 3-5 minutes or IV infusion over 30 minutes; >12 years Same as adult dose.
Adult: Initially, 6 mg/kg as a single loading dose given via IV. Maintenance (teicoplanin is added to the peritoneal dialysis fluid): 20 mg/L is added in each bag of dialysis solution in the 1st week, followed by 20 mg/L in alternate bags in the 2nd week, and then 20 mg/L in the overnight bag in the 3rd week.
Oral Clostridioides difficile infection
Adult: As alternative oral treatment (powder for inj/infusion may be used to prepare the oral solution) for antibiotic-associated colitis or diarrhoea caused by Clostridioides difficile: 100-200 mg bid for 7-14 days. Dosage recommendation may vary among individual products or between countries (refer to local detailed product guidelines).
Renal Impairment
Community-acquired pneumonia; Complicated skin and soft tissue infections; Complicated urinary tract infections; Hospital-acquired pneumonia; Bone and joint infections; Infective endocarditis:
Initially, administer the usual IV/IM doses for the 1st 3 days or 4 days of therapy. Thereafter, adjust the dose based on CrCl starting only on the 4th day or 5th day of treatment. Recommended day for the start of dose adjustments may vary between countries (refer to local guidelines). Patients undergoing haemodialysis: Reduce the maintenance dose to 1/3 of the usual dose (either by administering the maintenance dose every 3 days or by giving 1/3 of the maintenance dose once daily).
CrCl (mL/min)
Dosage
<30
Reduce the maintenance dose to 1/3 of the usual dose (either by administering the maintenance dose every 3 days or by giving 1/3 of the maintenance dose once daily).
30-80
Reduce the maintenance dose to half of the usual dose (either by administering the maintenance dose every 2 days or by giving half of the maintenance dose once daily).
Reconstitution
Powder for solution for inj/infusion or oral solution: Reconstitute a vial labelled as containing 200 mg or 400 mg with 3.14 mL of sterile water for inj to prepare a 200 mg/3mL or 400 mg/3mL concentration, respectively. Rotate slowly to dissolve the powder. Do not shake. If foam develops, allow the solution to stand for 15 minutes. Further dilute the reconstituted solution with a suitable IV fluid for infusion (e.g. NaCl 0.9% solution, dextrose 5% inj). Refer to local detailed product guidelines for further compatible infusion fluids. Reconstituted solution may be injected directly, further diluted for IV infusion or peritoneal dialysis solution, or prepared for oral administration.
Incompatibility
Incompatible with aminoglycoside solution when used for inj or infusion. However, teicoplanin and aminoglycoside solutions are compatible in dialysis fluid and may be used for CAPD-related peritonitis.
Contraindications
Hypersensitivity.
Special Precautions
Patient with known hypersensitivity or history of neutropenic reaction to vancomycin. Renal impairment. Children. Pregnancy and lactation.
Adverse Reactions
Significant: Haematologic effects (e.g. thrombocytopenia, neutropenia), hepatotoxicity, ototoxicity (e.g. tinnitus, deafness), nephrotoxicity (e.g. renal failure); bacterial or fungal superinfection (prolonged-use), including Clostridioides difficile-associated diarrhoea and pseudomembranous colitis. Rarely, infusion-related reactions or red man syndrome manifested as pruritus, urticaria, erythema, flushing of the upper body, hypotension, dyspnoea, tachycardia, and angioedema (due to rapid IV inj). Blood and lymphatic system disorders: Agranulocytosis, pancytopenia, leucopenia, eosinophilia. Ear and labyrinth disorders: Vestibular disorder, vertigo. Gastrointestinal disorders: Diarrhoea, vomiting, nausea. General disorders and administration site conditions: Fever, chills, inj site reactions (e.g. pain, erythema, inflammation, abscess). Investigations: Increased serum creatinine, serum transaminases, and blood alkaline phosphatase. Nervous system disorders: Headache, dizziness. Respiratory, thoracic and mediastinal disorders: Bronchospasm. Vascular disorders: Phlebitis. Potentially Fatal: Severe cutaneous reactions such as Stevens-Johnson syndrome, toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalised exanthematous pustulosis; severe hypersensitivity reactions (e.g. anaphylactic shock).
Patient Counseling Information
This drug may cause dizziness, if affected, do not drive or operate machinery.
Monitoring Parameters
Perform culture and susceptibility tests; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks. Closely monitor CBC with differential and platelet count; serum teicoplanin trough concentrations at steady state after the loading dose regimen and at least once weekly during maintenance treatment. Monitor LFTs periodically (prolonged use); renal and auditory function regularly (especially during long-term use or high loading doses in patients with renal impairment). Closely assess for signs of serious skin reactions and hearing impairment.
Overdosage
Symptoms: Agitation and nephrotoxicity. Management: Symptomatic treatment. Teicoplanin cannot be removed by haemodialysis.
Drug Interactions
Increased risk of nephrotoxic or ototoxic effects with aminoglycosides, colistin, amphotericin B, ciclosporin, cisplatin, furosemide, and etacrynic acid.
Action
Description: Mechanism of Action: Teicoplanin is a glycopeptide antibacterial agent that shows bactericidal activity against susceptible aerobic and anaerobic Gram-positive bacteria. It inhibits bacterial cell wall synthesis by binding into D-alanyl-D-alanine residues and blocking glycopeptide polymerisation, thereby inhibiting the growth of susceptible organisms. Pharmacokinetics: Absorption: Not absorbed from the gastrointestinal tract; rapidly and well absorbed after IM inj. Bioavailability: 90% (IM). Time to peak plasma concentration: 2-4 hours (IM). Distribution: Widely distributed into the lungs, myocardium, bone, skin and body fluids (including blister fluid and pleural, synovial or peritoneal fluids); poor penetration into the CSF. Plasma protein binding: Approx 88-95%, mainly to serum albumin. Metabolism: Minimally metabolised. Excretion: Oral: Via faeces (45% as unchanged drug). IV: Via urine (80% as unchanged drug); faeces (approx 3%). Elimination half-life: 100-170 hours.
Chemical Structure
Teicoplanin Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 133065662, Teicoplanin. https://pubchem.ncbi.nlm.nih.gov/compound/Teicoplanin. Accessed Apr. 28, 2023.
Storage
Intact vial: Store below 30°C. Protect from heat. Reconstituted and diluted solution: Store between 2-8°C for up to 24 hours.
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