Teicoplanin (three times weekly dosing)

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

This dosing regimen is based on Lamont E et al's thrice weekly teicoplanin guidelines. 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:

These resources also have more information on licensed indication, 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 dosing regimen is based on Lamont E et al's thrice weekly teicoplanin guidelines. 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.

Indication and dose
Licensed indication(s) in the OPAT setting Dose
Bone and joint infections See dose tables below

 

Off-label indications
Off-label indications in the OPAT setting Dose
Line or vascular access device infection See dose table below

 

Dose adjustments and monitoring
Patient characteristic Dosage advice
Renal impairment

See dosing table below

Renal replacement therapy: Please discuss dosing/dosage frequency with renal and infection specialists
Hepatic impairment No dose adjustment necessary
Obesity See dosing table below

 

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:
CrCl (ml/min)

140 – age (years) x weight (kg) x 1.23 (male) or 1.04 (female)
Serum creatinine (micromol/L)

(NB use minimum creatinine of 60 micromol/L)
Ideal body weight (IBW) kg

Males: 50 kg + 2·3 kg for every inch above 5 feet (or 2·5 cm above 152 cm)

Females: 45·5 kg + 2.3 kg for every inch above 5 feet (or 2·5 cm above 152cm)

or via link Ideal body weight tables (SAPG).
Adjusted body weight (AdjBW) kg IBW + (0.4 x (actual body weight – IBW))

 

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 

Loading dose for target concentration 10-20 mg/L - Use ideal body weight or actual body weight if lower  
Target concentration 10-20 mg/L 40-59 kg 60-79 kg 80 kg or more
CrCl less than 60 ml/min 600 mg 800 mg 1000 mg
CrCl 60 ml/min or higher 800 mg 800 mg 1000 mg

 

Loading dose for target concentration 20-30 mg/L - Use ideal body weight or actual body weight if lower 
Target concentration 20-30 mg/L 40-59 kg 60-79 kg 80 kg or more
CrCl less than 60 ml/min 1000 mg 1200 mg 1400 mg
CrCl 60 ml/min or higher 1200 mg 1400 mg 1600 mg

 

Maintenance dose
DO NOT use eGFR.  Creatinine clearance is calculated using 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 and target concentration to select the maintenance dose in the table below (for information on target therapeutic concentrations see below)

Start the maintenance dose 48 hours after the last loading dose.

CrCl ml/min 10-20mg/L target conc. 20-30mg/L target conc.
Less than 25 200mg 400mg
25-40 400mg 600mg
41-54 600mg 800mg
55-74 800mg 1000mg
75-89 800mg 1200mg
90-104 1000mg 1400mg
105-120 1000mg 1600mg
Over 120 1000mg 1800mg

 

Monitoring requirements
Frequency Recommended monitoring
Baseline Urea and Electrolytes (U&Es), liver function tests (LFTs), C-reactive protein (CRP) and full blood count (FBC)
Weekly monitoring U&Es, LFTs, CRP and FBC
(Note this may be more frequent than weekly if clinically necessary)
Therapeutic drug monitoring
  • Therapeutic drug monitoring is advised.
  • Blood samples may be sent to an external laboratory for analysis therefore may take 3–5 working days to be reported.
  • The first teicoplanin trough concentration should be taken ONE week after starting therapy (includes loading dose) and then WEEKLY thereafter (see target concentrations below).
  • Three times weekly dosing; teicoplanin trough concentrations must be taken at the end of the longest (72 hour) dose interval
  • Perform monitoring more frequently if clinically indicated (e.g. if renal function deteriorates or improves significantly; a change in creatinine of more than 15–20% during teicoplanin therapy)
Follow up Ensure follow up is arranged with referring specialty and/or an infection specialist

 

Target therapeutic teicoplanin concentrations:

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.

Indication Three times weekly dosing 
Target trough concentration
Line and vascular device infection 10-20 mg/L
Bone and joint infections 20-30 mg/L

 

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