Teicoplanin is indicated in adults and children for the treatment of the following infections:

• Complicated skin and soft tissue infections
• Bone and joint infections
• Hospital-acquired pneumonia
• Community-acquired pneumonia
• Complicated urinary tract infections
• Infective endocarditis

Teicoplanin may also be used as an alternative oral therapy for diarrhea and colitis associated with Clostridium difficile infection. When necessary, it should be administered in combination with other antibacterial agents.

Teicoplanin is a glycopeptide antibiotic produced by Actinoplanes teichomyceticus. It is supplied as a sterile, pyrogen-free, ivory-white powder that must be reconstituted with water for injection. It is freely soluble in water and, after reconstitution, forms a clear solution. Teicoplanin acts by inhibiting the growth of susceptible bacteria through interference with bacterial cell wall biosynthesis at a site different from that affected by beta-lactam antibiotics. It blocks peptidoglycan synthesis by specifically binding to D-alanyl-D-alanine residues.

Teicoplanin can be given intravenously (as a bolus injection or infusion) or intramuscularly. The intravenous injection should be administered either as a bolus over 3 to 5 minutes or as a 30-minute infusion. Only the infusion method should be used in neonates. It should be given once daily after one or more loading doses. The dosage of Teicoplanin should be adapted on the severity of the infection and patient’s response to treatment.

In adults (Normal kidney function):

• On the first day, a dose of 6 mg/kg (generally 400 mg) intravenously is recommended. On the following days, the dose may be 6 mg/kg/day (generally 400 mg) intravenously or 3 mg/kg/day (generally 200 mg) intravenously or intramuscularly as a single daily dose. The highest dose and the intravenous route are recommended for serious infections.
• In potentially fatal infections, treatment should be started with 6 mg/kg (usually 400 mg) twice daily for 1 to 4 days (loading dose) and continued with 6 mg/kg/day intravenously on the following days (maintenance dose).

In adults and elderly (Kidney failure): In patients with kidney failure, the dosage should be adjusted from the 4th day of treatment as follows:

• In moderate kidney failure (creatinine clearance between 40 and 60 ml/min), the daily dose of Teicoplanin should be halved or given on alternate days.
• In severe kidney failure (creatinine clearance less than 40 ml/min) and in hemodialysis patients, the daily dose of Teicoplanin should be reduced to a third, or given every 3 days.
• If creatinine clearance is equal to or less than 20 ml/min, treatment with Teicoplanin may be given only if monitoring of drug levels in the blood can be guaranteed.

In children (Normal kidney function):

• In Children (2 months to 12 years): Treatment should be started at a dose of 10 mg/kg every 12 hours for a total of 3 doses and then continued at a dose of 6-10 mg/kg/day, the highest dose being used for the most serious infections or for children with neutropenia.
• In neonates (up to 2 months): Treatment should be started at a dose of 16 mg/kg on the first day, followed by maintenance doses of 8 mg/kg/day by slow intravenous infusion (lasting approximately 30 minutes).

In children (Kidney failure): As like adults, dosage adjustment is recommended. Measuring Teicoplanin levels in the blood may be useful to make treatment as effective as possible.

Clostridium difficile infection associated diarrhea: The recommended dose is 100-200 mg administered twice a day for 7 to 14 days.

Giving Teicoplanin along with another suitable bactericidal antibiotic is recommended for infections requiring maximum bactericidal activity or in situations where the presence of Gram-negative bacteria cannot be ruled out (empirical treatment of fever in patients with neutropenia). In most patients, this medicine can be seen to have an effect 48 to 72 hours after the start of treatment. However, the total duration of treatment is determined based on the type and severity of the infection and the patient’s response to treatment. In endocarditis and osteomyelitis, a period of at least 3 weeks is recommended.

Because of the potential for increased adverse effects, Teicoplanin should be used with caution in patients receiving other nephrotoxic or ototoxic medicines at the same time, such as aminoglycosides, amphotericin B, cyclosporine, and frusemide.

Teicoplanin is contraindicated in patients with known hypersensitivity to this drug.

Local reactions: Erythema and injection site abscess may occur when administered intramuscularly.
Allergic reactions: Rash, pruritus, fever, shivering, and anaphylactic reactions may occur.
Gastrointestinal reactions: Nausea, vomiting, and diarrhea have been reported.
CNS reactions: Physical weakness, dizziness, and headache may occur.
Hearing reactions: Ringing in the ears and balance disorders have been reported.

Pregnancy Category B3. Teicoplanin should not be used during confirmed or suspected pregnancy, or during lactation, unless the potential benefit outweighs the possible risk.

Teicoplanin should be used with caution in patients who are known to be hypersensitive to vancomycin, as cross-hypersensitivity may occur.

Glycopeptide

Store below 30°C in a dry place. Protect from light. The reconstituted solution should be used immediately. If not used at once, it may be stored in a refrigerator at 2°C to 8°C for a maximum of 24 hours.