J Antimicrob Chemother. 2026 Feb 2;81(3):dkag038. doi: 10.1093/jac/dkag038.
ABSTRACT
BACKGROUND: Teicoplanin exhibits complex pharmacokinetics with substantial inter-patient variability. Therapeutic drug monitoring (TDM) is recommended to ensure adequate exposure, yet contemporary data on real-world prescribing practices are scarce. We evaluated current teicoplanin dosing and monitoring practices across UK and Irish hospitals.
METHODS: We conducted a multicentre, retrospective cohort study (Teicoplanin in UK: Study of Hospital Practice; TUcK-SHOP) across 21 hospitals. Adults receiving ≥5 days of intravenous/intramuscular teicoplanin with at least one TDM sample were included. Primary outcome was adherence to local or national dosing guidelines. Secondary outcomes included initial trough level attainment (≥20 mg/L) and laboratory-confirmed toxicity. Multivariable linear regression identified predictors of first trough concentrations.
RESULTS: A total of 391 patients met inclusion criteria (median age 69 years; 57.5% male). Guideline adherence was 66% overall but varied widely between sites (5%-100%). Most patients received three-dose loading (61.3%) with median maintenance dosing of 10.6 mg/kg daily (IQR 7.3-12.1). Median first trough level was 24.6 mg/L (IQR 17.9-33.2); only 40.8% of patients on 6 mg/kg maintenance achieved ≥20 mg/L versus 86.6% on 12 mg/kg (P < 0.001). Independent predictors of higher trough levels included lower creatinine clearance, longer time to TDM sampling, higher loading and maintenance doses, and greater body weight (adjusted R2 = 0.26, P < 0.001). Dose adjustments were required in 30% of patients.
CONCLUSIONS: Teicoplanin prescribing demonstrates significant variation across UK and Irish hospitals. Higher maintenance dosing (10-12 mg/kg) predicts therapeutic target attainment. These real-world data support the need for standardized dosing protocols to optimize teicoplanin therapy.
PMID:41710963 | DOI:10.1093/jac/dkag038
