Teconin

• Approved Indications:
• Treatment of serious infections caused by Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus epidermidis.
• Bone and joint infections.
• Infective endocarditis caused by susceptible Gram-positive organisms.
• Skin and soft tissue infections.
• Pneumonia due to Gram-positive pathogens.
• Bacteremia and septicemia caused by susceptible strains.
• Surgical prophylaxis in patients at high risk of infection during cardiac or orthopedic surgery.
• Off-label/Clinically Accepted Uses:
• Treatment of infections caused by Enterococcus species sensitive to glycopeptides.
• Alternative therapy in patients intolerant to vancomycin.

• Adults:
• Loading dose: 400 mg to 800 mg intravenously (IV) or intramuscularly (IM) every 12 hours for 3 to 5 doses, depending on severity.
• Maintenance dose: 400 mg to 800 mg once daily IV or IM.
• Duration varies from 7 to 14 days, extendable based on clinical response.
• Pediatrics:
• Loading dose: 10 mg/kg every 12 hours for 3 doses.
• Maintenance dose: 10 mg/kg once daily.
• Elderly:
• Dose adjustments may be needed based on renal function.
• Renal Impairment:
• For creatinine clearance <30 mL/min, extend dosing interval (e.g., every 48–72 hours).
• Administration:
• IV infusion over at least 30 minutes or IM injection.
• IM injections should be given deeply into a large muscle.

Teicoplanin is a glycopeptide antibiotic that inhibits bacterial cell wall synthesis by binding tightly to the D-alanyl-D-alanine termini of cell wall precursor units. This prevents the cross-linking of peptidoglycan chains essential for cell wall structural integrity, leading to bacterial cell lysis and death. It is bactericidal primarily against Gram-positive bacteria, including resistant strains like MRSA.

• Absorption: Not absorbed orally; administered IV or IM.
• Distribution: Widely distributed in tissues including bone, heart valves, and skin; approximately 90% plasma protein binding.
• Metabolism: Minimal metabolism.
• Half-life: 70 to 100 hours, supporting once-daily dosing after loading.
• Elimination: Primarily renal excretion of unchanged drug via glomerular filtration.
• Onset of action: Therapeutic plasma levels achieved quickly after loading doses.

• Pregnancy: FDA Category B. Animal studies have not demonstrated harm to the fetus, but well-controlled human studies are lacking. Use only if clearly needed.
• Lactation: Excreted in breast milk in small amounts; caution advised when administering to breastfeeding mothers due to potential effects on the infant.

• Glycopeptide antibiotic.

• Known hypersensitivity to teicoplanin or other glycopeptides.
• Severe renal impairment without appropriate dose adjustment.
• History of severe allergic reactions to glycopeptides or formulation excipients.

• Monitor for hypersensitivity and anaphylactic reactions.
• Risk of nephrotoxicity and ototoxicity, especially with concurrent nephrotoxic or ototoxic drugs.
• Regular monitoring of renal function and auditory function is recommended during prolonged therapy.
• Use cautiously in patients with renal impairment; adjust dose accordingly.
• Risk of Clostridioides difficile infection; monitor for diarrhea.
• Monitor infusion site for thrombophlebitis and tissue irritation.

• Common:
• Injection site reactions (pain, redness, inflammation).
• Rash, pruritus.
• Nausea, vomiting.
• Serious but rare:
• Anaphylaxis.
• Nephrotoxicity.
• Ototoxicity (hearing loss, tinnitus).
• Neutropenia, thrombocytopenia.
• Elevated liver enzymes.
• Clostridioides difficile-associated diarrhea.

• Increased risk of nephrotoxicity when used with other nephrotoxic agents (e.g., aminoglycosides, NSAIDs, cyclosporine).
• Possible additive ototoxic effects with aminoglycosides or loop diuretics.
• May potentiate effects of neuromuscular blocking agents.
• No significant CYP450 interactions reported.

• Teicoplanin remains an effective agent against MRSA and resistant Gram-positive infections.
• Guidelines recommend therapeutic drug monitoring in prolonged use to optimize efficacy and minimize toxicity.
• Dose adjustments emphasized in renal impairment.
• No new black box warnings; continued monitoring advised for hypersensitivity and nephrotoxicity.

• Store at controlled room temperature: 20°C to 25°C.
• Protect from light and moisture.
• Keep vial tightly closed until use.
• Reconstituted solutions should be used immediately or stored refrigerated and used within recommended time frames.