Teicoplanin Prescribing and Therapeutic
Drug Monitoring Clinical Guideline
V2.0
March 2019
Summary
Click here for the full guideline
Complicated skin and Bone and Infective Surgical
soft tissue infections, joint endocarditis prophylaxis
Pneumonia, Complicated infections
urinary tract infections
Loading dose
400 mg 800 mg 800 mg 400mg
intravenously, if intravenously if intravenously if intravenously
actual body weight actual body actual body or
under 70kg, every weight under weight under Open fractures;
12 hours for 3 70kg every 12 70kg every 12 800mg
doses hours for 3 doses hours for 5 doses intravenously
or 6 mg/kg actual Or 12 mg/kg Or 12 mg/kg
body weight every actual body actual body
12 hours for 3 weight every 12 weight every 12
administrations if hours for 3 doses hours for 3 doses
body weight over
70Kg
Maintenance Dose
400 mg 800 mg 800 mg
intravenously, if intravenously if intravenously if
actual body weight actual body weight actual body weight
under 70kg, or 6 under 70kg or 12 under 70kg or 12
mg/kg actual body mg/kg actual body mg/kg actual body
weight once a day weight once a day weight once a day
Teicoplanin Prescribing and Therapeutic Drug Monitoring Clinical Guideline V2.0
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Measurement of serum concentrations
Measure serum trough concentrations at steady state i.e. after
loading.
Adjust teicoplanin doses after the trough level is reported, do not
withhold doses pending trough level reports.
Dose adjustments in renal impairments
- not required until the fourth day of treatment
eGFR 30-60ml/min Half normal dose for weight given daily OR
Normal dose for weight given alternate days.
eGFR<30ml/min OR Haemodialysis patient 1/3 normal dose for
weight given daily OR Normal dose for weight given every 3rd
day.
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1. Aim/Purpose of this Guideline
1.1. To provide guidance to RCHT staff on the prescribing and therapeutic drug
monitoring for Teicoplanin therapy.
1.2. Data Protection Act 2018 (General Data Protection Regulation – GDPR)
Legislation
The Trust has a duty under the DPA18 to ensure that there is a valid legal basis
to process personal and sensitive data. The legal basis for processing must be
identified and documented before the processing begins. In many cases we may
need consent; this must be explicit, informed and documented. We can’t rely on
Opt out, it must be Opt in.
The DPA18 covers how the Trust obtains, hold, record, use and store all
personal and special category (e.g. Health) information in a secure and
confidential manner. This Act covers all data and information whether held
electronically or on paper and extends to databases, videos and other automated
media about living individuals including but not limited to Human Resources and
payroll records, medical records, other manual files, microfilm/fiche, pathology
results, images and other sensitive data.
DPA18 is applicable to all staff; this includes those working as contractors and
providers of services.
For more information about your obligations under the DPA18 please see the
‘information use framework policy’, or contact the Information Governance Team
rch-tr.infogov@nhs.net
2. The Guidance
2.1. For indications refer to the Trust Antimicrobial Guidelines on the Trust
intranet or Microguide app on mobile devices.
2.2. Teicoplanin distributes well into lung, myocardium and bone tissues, blister
fluids, synovial fluid and peritoneal fluid. Pleural fluid and subcutaneous fat tissue
penetration is adequate. Teicoplanin does not readily penetrate into the
cerebrospinal fluid (CSF).
2.3 No relationship between plasma concentrations and toxicity has been
established. Plasma concentrations can be used as a guide to optimise
treatment.
2.4 Long-term concurrent use of gentamicin and teicoplanin has the
potential to cause additive ototoxicity.
2.5 Trough concentrations should be above 15 milligrams/L (above 20
milligrams/L in patients with endocarditis or with deep-seated infections such as
those of the bones and joints) but less than 60 milligrams/L.
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2.6 Dosing and target trough level recommendations:
Please see below for dosing adjustments in renal impairment
Indication Loading dose Maintenance dose Target trough
-Complicated skin 400 mg intravenously, 6 mg/kg actual >15 mg/L and
and soft tissue if actual body weight body weight <60mg/L
infections under 70kg, every 12 intravenously once
hours for 3 doses a day
-Pneumonia
or
-Complicated
urinary tract 6 mg/kg actual body
infections weight every 12 hours
for 3 administrations if
body weight over 70Kg
-Bone and joint 800 mg intravenously if 12 mg/kg actual >20mg/L and
infections actual body weight body weight once <60mg/L
under 70kg every 12 a day
hours for 3 doses
or
12 mg/kg actual body
weight every 12 hours
for 3 to 5 doses
-Infective 800 mg intravenously if 12 mg/kg actual >30 mg/L and
endocarditis actual body weight body weight once <60mg/L
under 70kg every 12 a day
hours for 5 doses
or
12 mg/kg actual body
weight every 12 hours
for 5 doses
Surgical 400mg intravenously NA NA
prophylaxis up to 30 minutes before
procedure
Open fractures; 800mg
intravenously up to 30
minutes before skeletal
stabilisation and
definitive soft-tissue
closure
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2.7 Measurement of serum concentrations
2.7.1. Teicoplanin trough serum concentrations should be monitored at
steady state after completion of the loading dose regimen in order to ensure
that a minimum trough serum concentration has been reached.
2.7.2. Teicoplanin dose adjustments should not be made until the trough
level is reported. Do not withhold doses pending trough level reports.
2.7.3. Teicoplanin serum samples are sent to Bristol for analysis. Sample
turnaround times are between 2 and 5 days depending on the day the
sample is taken. Therefore, if the teicoplanin course is expected to be short,
it may not be practical to do teicplanin levels.
2.8 Dose adjustments in renal impairment
2.8.1. Dose adjustment is not required until the fourth day of treatment, at
which time dosing should be adjusted to maintain a serum trough
concentration of at least 10 mg/L.
2.8.2. After the fourth day of treatment:
Renal Function Dose
Aim Trough level >10mg/L
eGFR 30-60ml/min Half normal dose for weight given daily
OR
Normal dose for weight given alternate
days
(Whichever is more convenient)
eGFR<30ml/min 1/3 normal dose for weight given daily
OR OR
Haemodialysis patient Normal dose for weight given every 3rd day
(Teicoplanin is not cleared by (Whichever more convenient)
haemodialysis)
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3. Monitoring compliance and effectiveness
Element to be Appropriate dosing according to patient weight and infection type.
monitored Appropriate teicoplanin level monitoring.
Lead Antibiotic Pharmacist
Tool In development
Frequency Six monthly monitoring and reporting.
Reporting Antibiotic Stewardship Management Committee.
arrangements Recorded in meeting minutes
Acting on Antibiotic Stewardship Management Committee.
recommendations
and Lead(s)
Change in Required changes to practice will be identified and actioned within
practice and one month. A lead member of the team will be identified to take
lessons to be each change forward where appropriate. Lessons will be shared
shared with all the relevant stakeholders
4. Equality and Diversity
4.1. This document complies with the Royal Cornwall Hospitals NHS Trust
service Equality and Diversity statement which can be found in the 'Equality,
Inclusion & Human Rights Policy' or the Equality and Diversity website.
4.2. Equality Impact Assessment
The Initial Equality Impact Assessment Screening Form is at Appendix 2.
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Appendix 1. Governance Information
Teicoplanin Prescribing and Therapeutic
Document Title Drug Monitoring Clinical Guideline V2.0
Date Issued/Approved: February 2019
Date Valid From: March 2019
Date Valid To: March 2022
Directorate / Department responsible
Neil Powell, Pharmacist
(author/owner):
Contact details: 01872 252590
Brief summary of contents Teicoplanin prescribing and monitoring.
Suggested Keywords: Teicoplanin
RCHT CFT KCCG
Target Audience
Executive Director responsible for
Medical Director
Policy:
Date revised: October 2018
Clinical Guideline for Teicoplanin
This document replaces (exact title of
Prescribing And Therapeutic Drug
previous version):
Monitoring V1.0
Approval route (names of
Medicines Practice Committee
committees)/consultation:
Divisional Manager confirming
Iain Davidson
approval processes
Name and Post Title of additional
Not Required’
signatories
Name and Signature of {Original Copy Signed}
Divisional/Directorate Governance
Lead confirming approval by specialty
and divisional management meetings Name: Kevin Wright
Signature of Executive Director giving
{Original Copy Signed}
approval
Publication Location (refer to Policy Internet & Intranet Intranet Only
Teicoplanin Prescribing and Therapeutic Drug Monitoring Clinical Guideline V2.0
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on Policies – Approvals and
Ratification):
Document Library Folder/Sub Folder Clinical / Pharmacy
Links to key external standards https://www.medicines.org.uk/emc/
Related Documents: NA
Training Need Identified? NA
Version Control Table
Version Changes Made by
Date Summary of Changes
No (Name and Job Title)
Neil Powell, Antibiotic
May 2015 1.0 Initial issue
Pharmacist
October
Neil Powell, Antibiotic
2018 2.0 none
Pharmacist
All or part of this document can be released under the Freedom of Information
Act 2000
This document is to be retained for 10 years from the date of expiry.
This document is only valid on the day of printing
Controlled Document
This document has been created following the Royal Cornwall Hospitals NHS Trust
Policy for the Development and Management of Knowledge, Procedural and Web
Documents (The Policy on Policies). It should not be altered in any way without the
express permission of the author or their Line Manager.
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Appendix 2. Initial Equality Impact Assessment Form
This assessment will need to be completed in stages to allow for
adequate consultation with the relevant groups.
Name of Name of the strategy / policy /proposal / service function to be assessed
Teicoplanin Prescribing and Therapeutic Drug Monitoring Clinical Guideline V2.0
Directorate and service area: Is this a new or existing Policy:
CSSC, Pharmacy Existing
Name of individual completing assessment: Telephone:
Neil Powell 01872 252590
1. Policy Aim* Safe and effective teicoplanin prescribing
Who is the strategy /
policy / proposal /
service function aimed
at?
2. Policy Objectives* Safe and effective teicoplanin prescribing
3. Policy – intended Improve infection outcome through dose optimisation.
Outcomes*
4. *How will you Six monthly review
measure the
outcome?
5. Who is intended to Inpatients at Royal Cornwall Hospital
benefit from the
policy?
6a Who did you Workforce Patients Local External Other
consult with groups organisations
Please record specific names of groups
b). Please identify the
groups who have
Medication Practice Committee
been consulted about
this procedure.
What was the Guideline agreed
outcome of the
consultation?
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7. The Impact
Please complete the following table. If you are unsure/don’t know if there is a negative
impact you need to repeat the consultation step.
Are there concerns that the policy could have differential impact on:
Equality Strands: Yes No Unsure Rationale for Assessment / Existing Evidence
Age No
Sex (male, No
female, trans-gender /
gender reassignment)
Race / Ethnic No
communities
/groups
Disability - No
Learning disability,
physical
impairment, sensory
impairment, mental
health conditions and
some long term health
conditions.
Religion / No
other beliefs
Marriage and No
Civil partnership
Pregnancy and No
maternity
Sexual No
Orientation,
Bisexual, Gay,
heterosexual, Lesbian
You will need to continue to a full Equality Impact Assessment if the following have
been highlighted:
• You have ticked “Yes” in any column above and
• No consultation or evidence of there being consultation- this excludes any policies which have
been identified as not requiring consultation. or
• Major this relates to service redesign or development
8. Please indicate if a full equality analysis is recommended. No
tick
9. If you are not recommending a Full Impact assessment please explain why.
This guideline does not impact any of the groups listed above
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Signature of policy developer / lead manager / director Date of completion and submission
Neil Powell October 2018
Names and signatures of 1. Neil Powell
members carrying out the 2. Human Rights, Equality & Inclusion Lead
Screening Assessment
Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead
c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa,
Truro, Cornwall, TR1 3HD
This EIA will not be uploaded to the Trust website without the signature of the
Human Rights, Equality & Inclusion Lead.
A summary of the results will be published on the Trust’s web site.
Signed __ Neil Powell
Date ____ October 2018
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