Teicoplanin

Teicoplanin injection is indicated for the treatment of serious infections due to staphylococci or streptococci. Following infections are treated more satisfactorily-

• Prevention of infection (usually after surgery)
• Oesteomyelitis
• Septic arthritis
• Septicaemia
• Inflammation of the lining of the heart cavity and heart valves due to endocarditis
• Treatment of serious staphylococcal bacterial infections
• Non-cardiac bacteremia
• Dialysis associated peritonitis
• Severe infections-RTI, UTI, SSTI etc.

Teicoplanin is a glycopeptide antibiotic that has shown in vitro bactericidal activity against both anaerobic and aerobic gram-positive organisms. Teicoplanin inhibits the growth of susceptible organisms by interfering with cell-wall biosynthesis at a site different from that affected by beta-lactams. It is active against staphylococci (including those resistant to methicillin and other beta-lactam antibiotics), streptococci, enterococci, Listeria monocytogenes, micrococci, group JK corynebacteria and gram-positive anaerobes including Clostridium difficile and peptococci.

Adult or elderly patients with normal renal function:

Intravenously: Intravenous injection may be administered by rapid injection over 3-5 minutes, or slowly over a 30 minutes infusion by diluting with 0.9% Sodium Chloride or Hartmanns Solution or 5% Dextrose etc.

Intramascularly: An intramuscular injection of Teicoplanin should not exceed 3 ml at a single site.

Administration

3 ml water for injection should be added slowly down the side wall of the vial of Teicoplanin 200 mg or 400 mg. The vial should be rolled gently between the palms until the powder is completely dissolved. During the rolling, we have to be cautious about the solution that it does not become foamy. The solution must not be shaken. If foam formed then it should be allowed to stand for 15 minutes for the foam to be subsided. The entire contents from the vial should be withdrawn slowly into a syringe.

Teicoplanin should be administered with caution in patients receiving concurrent nephrotoxic or ototoxic drugs such as Aminoglycosides, Amphotericin B, Cyclosporine and Frusemide.

Teicoplanin is contraindicated in patients who have exhibited previous hypersensitivity to Teicoplanin.

Teicoplanin is generally well tolerated. Serious side-effects are rare. Side-effects are gastrointestinal like nausea, vomiting, diarrhea, CNS associated with urticaria, rash, anaphylactic shock as well as hearing problems like vertigo, tinnitus and vestibular disorder may occur.

There are no adequate and well-controlled studies in pregnant women about administration of Teicoplanin; this drug should be used during pregnancy only if clearly needed. Information about the excretion of Teicoplanin in milk is not known.

Teicoplanin should be administered with caution in patients with renal insufficiency, patients who require concurrent use of drugs which have ototoxic and/or nephrotoxic properties.

Glycopeptide

Patients with renal impairment: For patients with impaired renal function, reduction of dosage is not required until the fourth day of Teicoplanin treatment. From the fourth day of treatment-

In mild renal insufficiency: Teicoplanin dose should be halved either by administering the initial unit dose every two days, or by administering half of this dose once a day when creatinine clearance is 40-60 ml/min.

In severe renal insufficiency: Teicoplanin dose should be 1/3 of the normal either by administering the initial unit dose every third day or by administering 1/3 of this dose once a day when creatinine clearance is less than 40 ml/min and in haemodialysed patients. Teicoplanin is not removed by dialysis.