Teicoplanin 24-h loading dose regimen using a decision tree model to target serum trough concentration of 15–30 μg/mL: A retrospective study

• Published in: Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 2024-11
• Main Authors: Kondo, Shoji, Oda, Kazutaka, Kaneko, Tetsuya, Jono, Hirofumi, Saito, Hideyuki
• Format: Article
• Language: English
• Subjects: Decision tree model; Loading dose; Retrospective study; Teicoplanin; Therapeutic drug monitoring
• ISSN: 1341-321X; 1437-7780; 1437-7780
• DOI: 10.1016/j.jiac.2024.11.014

Teicoplanin (TEIC) is typically administered as a loading dose over 36–48 h. Achieving an effective concentration quickly is expected to treat severe infections, such as sepsis and methicillin-resistant Staphylococcus aureus infections. We aimed to identify the TEIC loading dose to be completed within 24 h, targeting the concentration of 15–30 μg/mL and factors affecting the loading dose by utilizing the decision tree (DT) model. Patients treated with TEIC between January 2017 and December 2022 who met the 24-h loading dose regimen were enrolled. A LD22.5 (corrected TEIC loading dose targeting concentration of 22.5 μg/mL) was determined, factors affecting the concentration were extracted, and a DT model was constructed. The validity of the DT was assessed using the coefficient of determination (R2) in the DT and population pharmacokinetics (PopPK) models for LD22.5. A total of 149 patients were divided into training (n = 104, 70 %) and test groups (n = 45, 30 %). We indicated an average of 14.5 mg/kg for LD22.5 and extracted four factors (estimated glomerular filtration rate, age, albumin, and C-reactive protein) from the DT model. The R2 values were 0.724, 0.695, 0.681, and 0.653 for the DT models (training and test groups) and two PopPK models, respectively. We established a 24-h loading dose regimen targeting the TEIC concentration of 15–30 μg/mL and identified four factors affecting the loading dose by using DT. By following the indicated DT algorithm flowchat, optimal decisions regarding the loading dose could be made for TEIC therapy.