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Rapid Attainment of Optimal Trough Concentrations in Organ Failure Mitigated by Teicoplanin

Shozo Yoshida, Hideshi Okada, Akio Suzuki, Keiko Suzuki, Takashi Niwa, Tomoaki Doi, Kunihiro Shirai, Kodai Suzuki, Yuichiro Kitagawa, Tetsuya Fukuta, Haruka Okamoto, Kazumasa Oda, Tomofumi Ohmori, Shiho Nakano, Michiyo Nakano, Takahiro Yoshida, Keisuke Kumada, Hiroaki Ushikoshi, Izumi Toyoda, Nobuo Murakami, Yoshinori Itoh and Shinji Ogura

The effective treatment of infections with teicoplanin requires an initial loading dose to reach optimal trough concentrations rapidly enough. The optimal dosage of teicoplanin was previously established, and an optimal trough concentration of 15-20 μg/mL was assumed based on weight and estimated creatinine clearance. Teicoplanin treatment was performed with software-based monitoring of teicoplanin concentrations. We compared serum chemistry parameters and sequential organ failure assessment (SOFA) scores in patients with initial teicoplanin trough concentrations <15 μg/mL or ≥ 15 μg/mL (low- and high-concentration groups, respectively). This study enrolled 29 patients (18 males, 11 females), including 4 patients receiving hemodiafiltration, who received initial teicoplanin injections between 2007 and 2010 at our hospital. Microbiological success rates did not differ significantly between the two groups, because additional teicoplanin was administered to patients whose initial trough concentrations were <15 μg/mL so as to attain this concentration. SOFA scores at 1 week post-treatment were significantly lower than those before treatment in the high-concentration group (before: 6.6 ± 3.8 vs. after: 5.3 ± 4.2, p<0.05), while there was no significant difference in the lowconcentration group (before: 7.8 ± 3.8 vs. after: 7.5 ± 3.5, p>0.05). Teicoplanin initial trough concentrations have been thought to contribute to improvement of organ failure. To maintain therapeutic concentrations of teicoplanin in patients with high disease severity, it was useful to ensure that initial trough values were ≥ 15 μg/mL. The initial dosage schedule of teicoplanin in emergency intensive care should consider disease severity.