Teicoplanin (daily dosing)

Outpatient parenteral antimicrobial therapy (OPAT) good practice prescribing guide for adults age 18 and over

This is a pragmatic ‘once daily’ dosing regimen extrapolated from Lamont E et al's thrice-weekly teicoplanin guideline. Please note this dosing differs from the manufacturer guidance and dose adjustments in the Renal Drug Database.

Teicoplanin is a glycopeptide with activity against a range of Gram-positive bacteria only.  It is licensed for a variety of indications including complicated skin and soft tissue infections, pneumonia, complicated urinary tract infections, bone and joint infections, infective endocarditis and peritonitis associated with continuous ambulatory peritoneal dialysis. 

This guide shares practical experience of the use of teicoplanin in an OPAT setting. We took an evidence based approach to create the guidance. We also used expert consensus and practical experience from across NHS Scotland.

This drug summary does not provide specific treatment guidance. Individual patient treatment should take into account the core principles of antimicrobial stewardship. This includes selection of the appropriate antimicrobial for the shortest duration with oral therapy being preferred, whenever possible.

For information on Route and method of administration, Contraindications, Cautions and adverse effects and Drug interactions please refer to the following approved resources:

• British National Formulary (BNF), https://bnf.nice.org.uk/
• Summary of Product Characteristics (SPC), https://www.medicines.org.uk/emc/
• The Renal Drug Database, https://renaldrugdatabase.com
• NHS Injectable Medicines Guide (Medusa), https://www.medusaimg.nhs.uk/ or local IV Drug monographs
• Stockley’s Drug Interactions, https://www.medicinescomplete.com/

These resources also have more information on licensed indications, use in pregnancy and use in breast feeding. When using unlicensed medicines, and/or off-label doses or indications, follow local health board governance processes.   

It is strongly recommended that OPAT services in Scotland adhere to the Key performance indicators for the management of patients in an outpatient parenteral antimicrobial therapy (OPAT) setting.

Teicoplanin

This is a pragmatic ‘once daily’ dosing regimen extrapolated from Lamont E et al's thrice-weekly teicoplanin guideline. Please note this dosing differs from the manufacturer guidance and dose adjustments in the Renal Drug Database.

Within this guide, the patient’s weight used to calculate creatinine clearance (CrCl) for the loading dose is different from that used to calculate the maintenance dose. This follows the pharmacokinetic model developed that best predicts teicoplanin trough concentrations within the recommended therapeutic range.

Renal function adjustment

Teicoplanin dosing is adjusted depending on renal function. The Cockcroft Gault equation is an established method for estimating a patient’s renal function. Creatinine clearance (CrCl) is estimated using the patient’s age, weight, serum creatinine and sex. 

Please note the patient weight used to calculate CrCl for the loading dose is different from that used to calculate the maintenance dose. (This follows the pharmacokinetic model developed that best predicts teicoplanin trough concentrations within the recommended therapeutic range).

Calculate creatinine clearance (CrCl) using the equations below:

Initial dosage regimen

Loading dose

DO NOT use eGFR. Creatinine clearance is calculated using the Cockcroft Gault equation above

Step one: Use actual body weight or adjusted body weight (for patients who weigh more than their ideal body weight) to calculate renal function using the calculation above

Step two: Use calculated renal function and ideal body weight or actual body weight if lower than ideal body weight to select loading dose in the table below 

Loading dose duration: Once daily for 3 consecutive days. 

Maintenance dose

DO NOT use eGFR. Creatinine clearance is calculated using the Cockcroft Gault equation (see calculations in above table). Use actual body weight (regardless of weight) to estimate CrCl for the maintenance dose. (This follows the pharmacokinetic model developed that best predicts teicoplanin trough concentrations within the recommended therapeutic range). 

Step one: Use actual body weight (regardless of weight) to calculate renal function using the calculation above

Step two: Use calculated renal function to select the maintenance dose in the table below 

Start the maintenance dose 24 hours after the last loading dose.

Target therapeutic teicoplanin concentration:

The following reference range refers to teicoplanin concentrations reported using an immunoassay bioanalytical method.  If the laboratory performs teicoplanin concentration analysis using an alternative method (e.g. HPLC) please refer to this laboratory for recommended reference ranges. 

For the use of other antibiotics in an OPAT setting please refer to the SAPG website

SAPG | Scottish Antimicrobial Prescribing Group : April 2025 for review April 2028
Content updated: May 2025