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Teicoplanin TDM — SCE Infectious Diseases MCQ

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ModerateAntimicrobial StewardshipTeicoplanin TDMSCE Infectious Diseases

A 60-year-old man is prescribed IV Teicoplanin for MRSA osteomyelitis. After 5 days, his clinical team notes that his blood cultures remain positive. Teicoplanin trough is measured at 8 mg/L. What is the target trough for deep-seated MRSA infections?

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Correct answer: D — Target trough ≥20 mg/L for deep-seated infections including endocarditis, osteomyelitis, and PJI — the current level of 8 mg/L is subtherapeutic

Teicoplanin TDM is essential for deep-seated infections. Target trough concentrations differ by infection type: ≥15 mg/L for most infections, but ≥20 mg/L for endocarditis, osteomyelitis, septic arthritis, and PJI. This patient's trough of 8 mg/L is significantly subtherapeutic, explaining treatment failure. Teicoplanin requires a loading dose (6 mg/kg every 12 hours for 3 doses, then daily) to achieve steady-state quickly due to its long half-life (~70 hours). Inadequate loading is the most common cause of subtherapeutic levels.

Reference: BNF 2024 – Teicoplanin; BSAC 2023 – TDM guidelines