Teicoplanin

• Brand names: Targocid
• Route: Intravenous and intramuscular

Teicoplanin is a glycopeptide complex that binds the D-alanyl-D-alanine terminus of peptidoglycan precursors and blocks cell-wall cross-linking.

It is heavily protein-bound with a long half-time, allowing once-daily dosing after loading and making it well suited to outpatient antibiotic therapy.

It can be given intramuscularly as well as intravenously, unlike vancomycin.

• Loading: 6 mg/kg (often 400–600 mg) every 12 hours for three to five doses, then 6 mg/kg once daily.
• Deep-seated infection such as endocarditis or bone and joint infection uses 12 mg/kg loading and maintenance, with trough monitoring.
• Trough targets are typically 15–30 mg/L for serious infection and higher for endocarditis.
• The maintenance interval is extended in kidney impairment after the full loading course is given.

Doses listed are typical adult regimens quoted for reference. The actual dose, route and duration are decided by a clinician for the individual patient.

Teicoplanin was isolated in 1978 from Actinoplanes teichomyceticus by researchers at Gruppo Lepetit in Italy, originally named teichomycin.

It was licensed in Europe in the late 1980s as a better-tolerated glycopeptide.

It has never been approved in the United States, so American guidelines rarely mention it.

• Generally better tolerated than vancomycin, with less kidney toxicity and no flushing reaction at usual rates.
• Rash and drug fever, which are more common than with vancomycin.
• Thrombocytopenia at high doses, raised liver enzymes and rare hearing effects.

• Serious infection with other Gram-positive organisms including enterococci and coagulase-negative staphylococci.
• Surgical prophylaxis in MRSA carriers and in penicillin-allergic patients undergoing joint replacement.