1. Clinical Overview
Teicoplanin is a glycopeptide antibiotic, structurally and functionally similar to vancomycin, used for the treatment of serious Gram-positive bacterial infections, particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA) and other resistant organisms. It is considered a second-line or alternative agent to vancomycin, often preferred in certain Indian clinical scenarios due to its once-daily dosing and potentially more favorable safety profile regarding nephrotoxicity and 'Red Man Syndrome'.
| Onset | Duration | Bioavailability |
|---|---|---|
| Peak serum concentrations are achieved approximately 1 hour after a 30-minute intravenous infusion. | The long half-life allows for once-daily dosing. Therapeutic serum concentrations are maintained for 24 hours post-dose. | Approximately 90% after intramuscular injection. Not absorbed orally. |
2. Mechanism of Action
Teicoplanin inhibits bacterial cell wall synthesis by binding with high affinity to the D-alanyl-D-alanine terminus of cell wall precursor units (lipid II). This binding prevents the incorporation of these subunits into the peptidoglycan matrix by inhibiting the transglycosylation step, a crucial process for cell wall cross-linking and rigidity.
3. Indications & Uses
- Complicated skin and soft tissue infections (cSSTI)
- Bone and joint infections (e.g., osteomyelitis, septic arthritis)
- Community-acquired pneumonia (Gram-positive component)
- Hospital-acquired pneumonia (HAP) including ventilator-associated pneumonia (VAP) caused by MRSA
- Bacteremia and septicemia caused by susceptible Gram-positive cocci
- Endocarditis (as an alternative to vancomycin for MRSA)
4. Dosage & Administration
Adult Dosage: Loading Dose: 400 mg IV every 12 hours for 3 doses. Maintenance Dose: 400 mg IV or IM once daily. For severe infections (e.g., endocarditis, osteomyelitis): Maintenance dose may be increased to 400 mg every 12 hours.
Administration: For IV use: Reconstitute 400mg vial with 3-4 mL of Water for Injections. Further dilute in 100-250 mL of compatible IV fluid (0.9% NaCl, 5% Dextrose, Ringer's Lactate). Infuse over 30 minutes. For IM use: Reconstitute with 3 mL of 1% Lidocaine HCl (without adrenaline) or Water for Injections. Administer by deep intramuscular injection. DO NOT administer IV push.
5. Side Effects
Common side effects may include:
- Pain at injection site (IM route)
- Phlebitis (IV route)
- Mild rash
- Fever
- Mild transient increase in liver enzymes (ALT/AST)
6. Drug Interactions
| Drug | Effect | Severity |
|---|---|---|
| Aminoglycosides (Gentamicin, Amikacin) | Increased risk of nephrotoxicity and ototoxicity. | Major |
| Loop Diuretics (Furosemide) | May potentiate ototoxicity. | Moderate |
| Other Nephrotoxic drugs (Amphotericin B, Cisplatin) | Additive risk of kidney damage. | Major |
| Warfarin | Potential increased anticoagulant effect; monitor INR closely. | Moderate |
| Ceftriaxone (in neonates) | Risk of precipitation in bile; avoid concomitant use in neonates. | Major |
7. Patient Counselling
- DO complete the full course of therapy even if you feel better.
- DO inform all your doctors and dentists that you are on this antibiotic.
- DO report any ringing in ears, dizziness, or hearing difficulty immediately.
- DONT skip doses.
- DONT take any other medicine (including OTC) without consulting your doctor.
8. Toxicology & Storage
Overdose: Symptoms may include exacerbation of adverse effects: severe ototoxicity (deafness, tinnitus), nephrotoxicity (acute renal failure), and hematological abnormalities (severe neutropenia).
Storage: Store unopened vials below 25°C, protected from light and moisture. Reconstituted solution in the vial is stable for 24 hours at 2-8°C. After further dilution in IV bag, use immediately or store at 2-8°C for not more than 24 hours. Do not freeze.