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To rapidly achieve teicoplanin trough (Cmin) concentrations ≥20 mg/l suggested for sternal sepsis, loading doses higher than 6 mg/kg 12-hourly might be warranted .
Patients (n = 10) with deep-seated Gram-positive infections were enrolled perioperatively. During the first 4 days of therapy teicoplanin loading doses of 12 mg/kg 12-hourly were administered for 48 hours and 12 mg/kg once daily thereafter. Surgical debridement was performed on D3. Samples were collected 15 minutes before and 30 minutes and 120 minutes after each teicoplanin administration. Total and unbound teicoplanin levels were determined using HPLC.
All patients had hypoalbuminemia (mean 20.2 g/l). The SS PK parameters of teicoplanin are described in Table Table1.1. On D3 the median total and free Cmin were 14.66 (8.93 to 19.66) and 3.09 (0.0 to 6.4) mg/l, respectively. In a multivariate logistic regression model, total teicoplanin concentrations (P = 0.174) and serum creatinine concentration (P = 0.034) did not impact significantly on free teicoplanin levels whereas, in contrast, albumin concentration did (OR 0.120, 95% CI 0.078 to 0.161, P < 0.001).
The levels achieved on D3 in this study are similar to those achieved by Mimoz and colleagues using the same dosing schedule in ICU patients with VAP . Only hypoalbuminemia impacted on the free levels of teicoplanin in this setting. High teicoplanin loading doses of 12 mg/kg 12-hourly should probably be extended beyond 48 hours, before major elective surgery for chronic bone sepsis.