teicoplanin: clinical use

Prescribing considerations

• Confirm that likely or proven pathogens fall within teicoplanin's limited Gram-positive spectrum; combination antibacterial therapy may be needed.
• Account for renal function because teicoplanin is predominantly eliminated unchanged in urine.
• Review previous glycopeptide reactions and concurrent nephrotoxic, neurotoxic or ototoxic medicines.
• Oral teicoplanin acts locally because gastrointestinal absorption is negligible.

Contraindications and cautions

• Hypersensitivity to teicoplanin or a product excipient.
• Do not administer by the intraventricular route.
• Use caution with previous vancomycin hypersensitivity because cross-reactions can occur.

Monitoring

• Renal function and clinical response.
• Full blood count, including platelets, during treatment.
• Liver-function tests where clinically appropriate.
• Serum teicoplanin concentrations, particularly when required to confirm adequate exposure or in complex clinical circumstances.
• Hearing and vestibular symptoms, especially with renal impairment, prolonged treatment or other ototoxic medicines.
• Skin and systemic features of severe cutaneous adverse reactions.

Clinical pharmacology

Teicoplanin is a highly protein-bound glycopeptide that blocks bacterial peptidoglycan synthesis by binding D-alanyl-D-alanine residues. It has a long elimination half-life, undergoes little metabolism and is cleared mainly through the kidneys.

Formulation and product differences

• The selected generic presentation includes solvent, whereas the selected Targocid presentation is supplied as powder for reconstitution.
• Vial construction, sodium declarations, solution appearance and detailed preparation instructions are product-specific.
• Reconstituted solution may be used parenterally or, for the licensed C. difficile indication, orally; consult the individual SmPC before preparation.

Oral solution

Route: Oral

Strengths: 200 mg, 400 mg