Therapeutic drug monitoring of the teicoplanin trough level after the loading doses in patients receiving venoarterial extracorporeal membrane oxygenation

Guan-Jhou Chen; Shu-Wen Lin; I-Lin Tsai; Ching-Hua Kuo; Jann-Tay Wang; Szu-Min Hsieh

doi:10.1016/j.jfma.2019.10.005

Therapeutic drug monitoring of the teicoplanin trough level after the loading doses in patients receiving venoarterial extracorporeal membrane oxygenation

J Formos Med Assoc. 2020 Jun;119(6):1086-1092. doi: 10.1016/j.jfma.2019.10.005. Epub 2019 Oct 28.

Authors

Guan-Jhou Chen¹, Shu-Wen Lin², I-Lin Tsai³, Ching-Hua Kuo⁴, Jann-Tay Wang⁵, Szu-Min Hsieh⁶

Affiliations

¹ Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yunlin County, Taiwan.
² Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
³ Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Biochemistry and Molecular Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁴ Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; The Metabolomics Core Laboratory, Center of Genomic Medicine, National Taiwan University, Taipei, Taiwan.
⁵ Section of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
⁶ Section of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan. Electronic address: hsmaids@hotmail.com.

PMID: 31672434
DOI: 10.1016/j.jfma.2019.10.005

Abstract

Background: The optimal loading dose of teicoplanin in patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) has never been determined by therapeutic drug monitoring. This study investigated the appropriateness of proposed loading dose regimens of teicoplanin when administered to patients receiving VA-ECMO by using a previously proposed loading dosage and measuring the teicoplanin trough concentration (C_trough).

Methods: Patients who initiated teicoplanin therapy while receiving VA-ECMO were enrolled. Every included patient received four loading doses of teicoplanin at a dose of 12 mg/kg. The first three doses were administered 12 h apart, and the fourth dose was administered 24 h after the third dose. Blood samples were collected before administering the maintenance dose (i.e., the fifth dose), and the teicoplanin C_trough was measured. Serum teicoplanin levels were determined using an Agilent 1290 ultra-high performance liquid chromatography system.

Results: The teicoplanin C_trough was successfully tested in 11 patients. Their median age was 68.2 years, and 81.8% of them were men. The median of each loading dose was 11.6 (range, 10.7-12.8) mg/kg. The median teicoplanin C_trough was 22.01 (range, 14.85-44.84) mg/L. All patients had a C_trough of more than 10 mg/L, whereas 90.9% (10/11) of the patients achieved a C_trough of more than 15 mg/L.

Conclusion: The loading dosage consisting of four doses of teicoplanin administered within the first 72 h at a dose of 12 mg/kg/dose could achieve an adequate therapeutic C_trough of teicoplanin in patients receiving VA-ECMO.

Keywords: Glycopeptides; Nephrotoxicity; Pharmacokinetics; Teicoplanin; Therapeutic drug monitoring.

MeSH terms

Aged
Anti-Bacterial Agents* / pharmacokinetics
Chromatography, High Pressure Liquid
Drug Monitoring
Extracorporeal Membrane Oxygenation*
Female
Humans
Male
Teicoplanin* / pharmacokinetics

Substances

Anti-Bacterial Agents
Teicoplanin