Abstract
Background:
Teicoplanin is widely used to treat Gram-positive infections in adult cancer patients, but early attainment of recommended trough concentrations and clinical determinants of those concentrations are not well characterized in patients receiving standardized, high-dose loading regimens.
Objective:
This study aimed to characterize day 4 teicoplanin trough concentrations and to identify clinical predictors of under- and over-target levels in adult cancer patients receiving a standardized high-dose loading regimen.
Methods:
This retrospective study included adult cancer patients who received a standardized high-dose teicoplanin loading regimen (600 mg intravenously twice daily on days 1-2 and once on day 3) and had a post-loading trough measurement on day 4. Patients were classified as under (< 20 mg/L), within (20-30 mg/L), or over target (> 30 mg/L). Clinical variables were compared across groups, and multivariable Firth-penalized logistic regression analysis was used to identify factors associated with under- and over-target trough concentrations vs within-target ones.
Results:
The study included 211 patients: 71 (33.6%) in the under-, 112 (53.1%) in the within-, and 28 (13.3%) in the over-target group. Higher body weight and febrile neutropenia were associated with higher odds of under-target trough concentrations, whereas higher serum albumin was associated with lower odds; febrile neutropenia was associated with lower odds of over-target concentrations.
Conclusion and Relevance:
The fixed high-dose loading regimen of teicoplanin evaluated in this study achieves a day 4 trough concentration of 20 to 30 mg/L in about half of adult cancer patients. Higher body weight, febrile neutropenia, and lower serum albumin may help identify patients who require intensified loading and early therapeutic drug monitoring.
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