Teicoplanin (Targocid) is a class of antibiotics that belongs to the semisynthetic glycopeptides with a similar spectrum of activity as vancomycin against gram-positive bacteria.

It is used to treat infections caused by susceptible gram-positive bacteria.

It is also used as a prophylaxis against endocarditis caused by gram-positive bacteria in dental surgery and peritonitis associated with Continuous Ambulatory peritoneal dialysis.

Teicoplanin Vs Vancomycin:

• Teicoplanin and vancomycin have almost the same spectrum of coverage and similar efficacy against most gram-positive bacteria. Both the drugs are not effective in the treatment of gram-negative organisms.
• Both drugs are available in the form of injectables. The oral formulation is not available. Although vancomycin may be given orally for pseudomembranous colitis, it is not systemically absorbed following administration via the oral route.
• Teicoplanin has a longer half-life compared to vancomycin. The dosing schedule of teicoplanin is easier and may be given as a once-daily injection. Contrary to teicoplanin, vancomycin is given in two or three divided doses.
• Because of the pharmacokinetic properties of teicoplanin, it may be given as an intramuscular injection or as a rapid intravenous infusion. Vancomycin is given as a slow intravenous infusion over one hour.
• Furthermore, drug levels do not need to be monitored with teicoplanin. Trough levels are usually monitored in patients on vancomycin injections.
• Although teicoplanin is more costly than vancomycin, regular drug level monitoring and treatment of the side effects might level of the cost issue.
• Teicoplanin has fewer side effects compared to vancomycin. Thrombocytopenia and drug reactions have been seen commonly with its use. Vancomycin is more nephrotoxic and is associated with histamine-induced flushing (red man syndrome) especially when infused rapidly.

The MIC (minimum inhibitory concentration) data for the commonly susceptible organisms is given here:

• Clostridium difficile: 0.06 μg/ml - 0.5 μg/ml
• Staphylococcus aureus: ≤0.06 μg/ml - ≥128 μg/ml
• Staphylococcus epidermidis: ≤0.06 μg/ml - 32 μg/ml

Targocid (Teicoplanin) usual dosage in Adults:

• 6 mg/kg (∼400 mg) on the first day, followed by 3 mg/kg (∼200 mg) once daily thereafter.

Teicoplanin for severe infections:

• 6 mg/kg (∼400 mg) given twice daily for 3 doses, followed by 6 mg/kg/day;
• (doses up to 12 mg/kg/day may be used)

Targocid for the treatment of Clostridium difficile infection

• Adult dose: 100–200 mg twice daily per oral for 10–14 days

Targocid dosage for serious infection caused by Gram-positive bacteria such as complicated skin and soft tissue infections and pneumonia:

Adults with a body-weight up to 70 kgs:

• Initially 400 mg every 12 hours for 3 doses, followed by 400 mg once daily by an intravenous infusion, intravenous injection or intramuscular injection.

Adults with a body-weight of 70 kgs and above:

• Initially 6 mg/kg every 12 hours for 3 doses, then 6 mg/kg once daily by an intravenous infusion, intravenous injection or intramuscular injection.

Targocid for Streptococcal or enterococcal endocarditis (in combination with another antibacterial):

• Adults: Initially 10 mg/kg every 12 hours for 3–5 doses, then 10 mg/kg once daily via an intravenous infusion or intravenous injection.
• Subsequent doses can be given by intramuscular injection

Teicoplanin dosage for Bones and joint infections

• Adults: Initially 12 mg/kg every 12 hours for 3–5 doses by an intravenous injection of infusion, then 12 mg/kg once daily subsequent doses can be given by intramuscular injection, increased risk of fever and rash with doses of 12 mg/kg.

Targocid dosage for Surgical prophylaxis

• Adults: 400 mg, to be administered up to 30 minutes before the procedure by intramuscular injection.

Targocid dosage for Surgical prophylaxis in open fractures

• Adults: 800 mg, to be administered up to 30 minutes via an intramuscular injection before skeletal stabilization and definitive soft-tissue closure.

Targocid dosage for Peritonitis associated with peritoneal dialysis (added to dialysis fluid):

• Adults: A single loading dose of intravenous 400 mg, followed by 20 mg/l per bag in the first week, 20 mg/l in the alternate bag in the second week and 20 mg/l in the overnight dwell bag only during the third week.
• Patients who are febrile must take 400 mg of teicoplanin as an intravenous loading dose.

Teicoplanin (Targocid) dose in children:

• 10 mg/kg intravenously twice daily for 3 doses, then 6 mg/kg I.V. or I.M. once daily

Targocid for severe infections:

• 10 mg/kg intravenous twice daily for 3 doses, followed by 10 mg/kg I.V. or I.M. once daily

Pregnancy Category C

• Manufacturers recommend that you only use it if there are greater benefits than risks.
• It is not known if it can be used during breastfeeding. 

Teicoplanin renal dose:

eGFR of 30 - 80 ml/min/1.73m2:

• On days 1-4, Use the normal dose regimen, then use the normal maintenance dose every 48 hours.

eGFR of less than 30 mL/minute/1.73m2:

• On days 1-4, Use the normal dose regimen, then use the maintenance dose every 72 hours.

Plasma-teicoplanin concentration should be monitored during parenteral maintenance treatment. Also, monitor renal and auditory function during prolonged treatment in renal impairment.

Dose in Liver disease:

The manufacturer does not provide dosage adjustment in liver diseases.

Teicoplanin side effects:

• Pruritus,
• rash,
• bronchospasm,
• diarrhea,
• dizziness,
• eosinophilia,
• fever,
• headache,
• leucopenia,
• mild hearing loss,
• nausea,
• thrombocytopenia,
• thrombophlebitis,
• tinnitus,
• vestibular disorders,
• vomiting,
• exfoliative dermatitis,
• nephrotoxicity,
• renal failure,
• Stevens-Johnson syndrome, and
• toxic epidermal necrolysis.

Note: Teicoplanin is less nephrotoxic than vancomycin. 

Contraindications and warnings

• Teicoplanin hypersensitivity should be avoided in patients with Hypersensitivity to vancomycin can lead to cross-sensitivity.
• Teicoplanin should be avoided in patients who have a history of hypersensitivity to vancomycin.
• However, a history of "redman syndrome" is not considered to be a contraindication to teicoplanin.

Monitor:

• It is not recommended to monitor plasma teicoplanin levels routinely.
• Plasma teicoplanin levels can be helpful in optimizing doses for deep-seated staphylococcal infection like osteomyelitis, endocarditis and intravenous drug users.
• These situations call for a trough level of more than 20 mg/liter to reach maximum levels of 60 mg/liter.
• Patients with elderly should also have their plasma teicoplanin levels checked.
• Monitoring of blood counts, liver and kidney function tests should also be monitored. 

How to administer Teicoplanin (Targocid)?

• Teicoplanin can be injected as an intravenous bolus or a slow intravenous infusion over 30 minutes.
• It is usually given as a once-daily injection but in severe cases, a second bolus can be given to reach the required serum concentration.
• The administration of teicoplanin via the intraventricular route is not indicated.
• Teicoplanin is not indicated to be used for more than four months.

Teicoplanin mechanism of action:

• Teicoplanin, a bactericidal antibacterial, is produced from the fermentation of actinoplanes Teichomyceticus. 
• It is active against both Gram-positive and Gram-negative anaerobes. Bacteria which are sensitive ( MIC of less than 16 mg/l):
  • Staphylococcus aureus
  • Coagulase-negative staphylococci
  • Streptococci
  • Enterococci
  • Listeria monocytogenes
  • Micrococci
  • Eikenella corrodens
  • Group JK corynebacteria
  • Gram-positive anaerobes including clostridium difficile and peptococci
  • Bacteria usually resistant to teicoplanin (MIC of greater than 16 mg/l)
  • Nocardia asteroides
  • Lactobacillus spp
  • Leuconostoc and
  • All gram-negative bacteria.

International Brand names:

• Targocid
• Targosid

Teicoplanin brand names in Pakistan:

Planin (S.J. & G. Fazul Ellahie (PVT) LTD

Vial 200 mg: Rs. 900

Tapocin ( Hoffman Health Pakistan LTD)

Vial 200 mg: Rs. 1300

Targocid (Sanofi Aventis Pakistan LTD)

Vial 200 mg: Rs. 1560

Vial 400 mg: Rs. 3120

Teicon (A.j. Mirza PVT LTD)

Vial 400 mg: Rs. 2108

Teicox (Rotex Medica PVT LTD)

Vial 200 mg: Rs. 1300

Vial 400 mg: Rs. 2108