Pharmacokinetic–pharmacodynamic aspects of antimicrobial prophylaxis with teicoplanin in patients undergoing major vascular surgery

• Published in: International journal of antimicrobial agents 2006, Vol.27 (1), p.15-19
• Main Authors: Pea, Federico, Furlanut, Mario, Stellini, Roberto, Bonardelli, Stefano, Signorini, Liana, Pavan, Federica, Matheis, Albert, Portolani, Nazario, Lorenzotti, Silvia, Giulini, Stefano Maria, Viale, Pierluigi, Carosi, Giampiero
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anti-Bacterial Agents - blood; Anti-Bacterial Agents - pharmacokinetics; Anti-Bacterial Agents - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Chemoprevention; Dose-Response Relationship, Drug; Female; Humans; Male; Medical sciences; Middle Aged; Pharmacodynamics/pharmacokinetics; Pharmacology. Drug treatments; Prospective Studies; Surgical prophylaxis; Teicoplanin; Teicoplanin - blood; Teicoplanin - pharmacokinetics; Teicoplanin - therapeutic use; Therapeutic drug monitoring; Vascular Surgical Procedures
• ISSN: 0924-8579; 1872-7913
• DOI: 10.1016/j.ijantimicag.2005.09.009

A prospective, two-arm, open study assessing plasma exposure to teicoplanin with two different prophylactic regimens (Group A ( n = 23), 800 mg pre-operatively versus Group B ( n = 24), 400 mg pre-operatively plus two doses of 200 mg 24 h apart) was carried out in patients undergoing major vascular surgery. The intent was to define the feasibility and the possible advantages of the single pre-operative high dose in ensuring therapeutically effective plasma concentrations (>10 mg/L) of teicoplanin even during long-lasting operations. At the end of the intervention, mean teicoplanin concentrations (±S.D.) were 14.05 ± 5.13 mg/L and 5.39 ± 2.13 mg/L in Groups A and B, respectively. At 24 h, average teicoplanin levels were 5.10 ± 1.25 mg/L and 2.08 ± 0.73 mg/L in Groups A and B, respectively; at 48 h they declined to 2.86 ± 0.70 mg/L in Group A, whereas they rose to 2.67 ± 0.82 mg/L after administration of 2.63 ± 0.51 mg/kg at 24 h in Group B. Single pre-operative high-dose teicoplanin may ensure effective plasma levels even in cases of very long-lasting operations (>8 h) with no need for intraoperative re-dosing and may enable more appropriate prophylactic exposure than that achievable with the same total dose given in three administrations 24 h apart.