Appendix 2 - Teicoplanin dosing for Hospital at Home patients

Antimicrobial prescribing: NHS Lothian
NHS Lothian

Teicoplanin dosing for Hospital at Home patients
(Note this differs from the OPAT regimen and aims for target trough of 10-20mg/L).

Teicoplanin is loaded over three consecutive days (Days 1, 2 and 3) and this will provide equivalent to 5 days of treatment.

Teicoplanin should not be extended past the initial 5 days loading duration without input from an Infection specialist.  This teicoplanin regimen is intended for skin/soft tissue infections and pneumonia but not for deep-seated infections (e.g. bone and joint infection or endocarditis).  If a deep seated infection is being treated please contact an infection specialist for guidance and use an alternative regimen.

Patient’s age, height, weight and a stable serum creatinine are required to calculate the teicoplanin loading dose using the following steps:

Step 1:

Calculate Creatinine Clearance

·         Calculate using patient’s height, weight & serum creatinine

·         Intranet calculator available here or in Right Decisions®

·         Other online calculators could be used as long as they use the Cockcroft-Gault formula.

 

As a last resort, calculate manually:

CrCl (ml/min) = [ (140 - Age) X weight* X 1.23(male) or 1.04(female) ] / Serum creatinine**) 

 

*Use actual or MAXIMUM body weight, whichever is the lower

** Use If Cr <60 mmol/L, use a value of 60. 

Step 2:

Decide on using Ideal or Actual Body Weight

Step 3:

Prescribe doses:

 

 

Prescribe daily for first 3 days:

Creatinine Clearance (ml/min)

Ideal/Actual body weight (kg)

40-59 kg

60-79 kg

>80 kg

<60

600 mg

800 mg

1000 mg

>60

800 mg

800 mg

1000 mg

 

References

·         Lamont et al.  Journal of Antimicrobial Chemotherapy 2009; 64 : 181-187 dosing for target trough of 10-20mg/L

·         Summary of Product Characteristics, Targocid 400mg

 

Patient Details

Name

DOB

Address

Use attached Teicoplanin dosage guideline to calculate doses

·   Creatinine =

 

_____________________

micromol/L

·   Height=

 

_____________________

feet/ inches

·   Age =

 

_____________________

years

·   Total body weight
(weight as per scales)=

 

_____________________

kilograms

·  Creatinine clearance =

 

_____________________

mL/min

·   Ideal body weight=

 

_____________________

kilograms

 

Choose appropriate LOADING dose regimen from table.  Using IBW if patient overweight. Use TBW if this is lower than IBW.

  • Loading dose =

 

To be administered on the following consecutive days:

Day 1

Day 2

Day 3